Right Heart Function and Scleroderma: Insights from Tricuspid Annular Plane Systolic Excursion

Lee, Chiu-Yen; Su, Chang; Hsiao, Shih-Hung; Tseng, Jui-Cheng; Lin, Shih-Kai; Liu, Chun–Peng

doi:10.1111/j.1540-8175.2007.00365.x

Cited by 60 publications

(31 citation statements)

References 23 publications

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“…14,15 There has been a wide range of correlations between TAPSE and other measures of RV function. Good correlations were obtained comparing TAPSE with RVEF, [16][17][18][19][20] and better correlations were obtained comparing TAPSE with RV fractional area of change 6,12 and global RV strain. 21 Correlations were more modest when compared with RVEF using magnetic resonance imaging.…”

Section: Discussionmentioning

confidence: 89%

Evaluation of TAPSE as a measure of right ventricular output

Tousignant

Kim

Papa

et al. 2012

Can J Anesth/J Can Anesth

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Purpose This study was designed to show the relationship between tricuspid annular plane systolic excursion (TAPSE) and stroke volume (SV) by thermodilution using three different methods and also to assess whether TAPSE can track hemodynamic changes associated with volume loading and ephedrine administration. Methods This was an observational study in 61 elective patients with a pulmonary artery catheter who were undergoing coronary artery bypass graft surgery in a cardiac surgical centre. We measured TAPSE by three methods using transesophageal echocardiography: M mode, speckle tracking at the lateral wall, and tissue tracking at the inferior wall. There were two interventions: leg raising (volume recruitment) or administration of ephedrine 5 mg iv. Echo and hemodynamic measurements were performed before and after each intervention.Results Eleven patients were excluded due to poor imaging. There were 26 patients in the leg raising group and 24 patients in the ephedrine group. The correlation coefficient between stroke volume (SV) and TAPSE by M mode, speckle tracking, and tissue tracking was 0.48, 0.44, and 0.09, respectively. There was a significant increase in SV following each intervention; however, the changes in TAPSE by any method and velocity were not large enough to reach statistical significance. Conclusion Tricuspid annular plane systolic excursion by M mode and by speckle tracking correlates modestly with SV. There was no correlation between TAPSE and SV by tissue tracking at the inferior wall of the right ventricle. Tricuspid annular plane systolic excursion by M mode and by speckle tracking does not track changes in SV following either volume loading or ephedrine administration. RésuméObjectif Cette e´tude a e´te´conçue pour montrer le rapport entre le de´placement systolique du plan de l'anneau tricuspidien (TAPSE) avec le volume d'e´jection systolique (SV) par thermodilution en utilisant trois me´thodes diffe´rentes et aussi pour de´terminer si le TAPSE peut suivre les modifications he´modynamiques associe´es a`une charge volumique et a`une administration d'e´phe´drine. Méthodes Il s'agit d'une e´tude observationnelle mene´e chez 61 patients se´lectionne´s porteurs d'un cathe´ter de l'arte`re pulmonaire qui devaient subir un pontage coronarien dans un centre de chirurgie cardiaque. Nous avons mesure´le TAPSE par trois me´thodes diffe´rentes al 'aide d'une e´chocardiographie transoesophagienne: mode M;suivi de granularite´s (speckle tracking) sur la paroi late´rale; et suivi de tissu (tissue tracking) sur la paroi infe´rieure. Il y a eu deux interventions: jambes releve´es

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Section: Discussionmentioning

confidence: 89%

Evaluation of TAPSE as a measure of right ventricular output

Tousignant

Kim

Papa

et al. 2012

Can J Anesth/J Can Anesth

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“…TAPSE has been shown to predict morbidity and mortality in patients with PAH and has become a recommended method for measuring the efficacy of PH medical therapy in PAH. 11,13,14 Previous work has shown that longitudinal RV shortening accounts for approximately 80% of global RV function in normal subjects and that longitudinal function represents the afterload-responsive element of right heart function in subjects with PAH treated with PH medical therapy. 9 Until now, TAPSE has been thought of as a method specific to RV function, with the direct or indirect role of RA function not known.…”

Section: Resultsmentioning

confidence: 99%

Assessment of the Physiologic Contribution of Right Atrial Function to Total Right Heart Function in Patients with and without Pulmonary Arterial Hypertension

2016

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Total right heart function requires normal function of both the right ventricle and the right atrium. However, the degree to which right atrial (RA) function and right ventricular (RV) function each contribute to total right heart function has not been quantified. In this study, we aimed to quantify the contribution of RA function to total right heart function in a group of pulmonary arterial hypertension (PAH) patients compared to a cohort of normal controls without cardiovascular disease. The normal cohort comprised 35 subjects with normal clinical echocardiograms, while the PAH cohort included 37 patients, of whom 31 had echocardiograms before and after initiation of PAH-specific therapy. Total right heart function was measured via tricuspid annular plane excursion (TAPSE). TAPSE was broken down into two components, the excursion occurring during RA contraction (TAPSE RA ) and that occurring before RA contraction (TAPSE RV ). RA fractional area change (RA-FAC) was also compared between the two groups. In the PAH cohort, more than half of the total TAPSE occurred during atrial systole, compared to less than one-third in the normal cohort (51.0% vs. 32.1%; P < 0.0001). There was a significant correlation between RA-FAC and TAPSE in the PAH cohort but not in the normal cohort. TAPSE improved significantly in the posttreatment cohort (1.7 vs. 2.1 cm), but TAPSE RA continued to account for about half of the total TAPSE after treatment. RA function accounts for a significantly greater proportion of total right heart function in patients with PAH than in normal subjects. Pulmonary arterial hypertension (PAH) is characterized by marked increases in right ventricular (RV) afterload, which if left untreated leads to progressive RV dysfunction, exercise intolerance, and potentially death.1-3 As recently emphasized by the International Right Heart Foundation Working Group, the right ventricle (also RV) is only one part of the total right heart system, and the other components, including the right atrium (RA), contribute importantly to total right heart function. 4It has been recognized that in the setting of RV failure, preserved right atrial (also RA) function is essential to maintain adequate total right heart function. After RV infarction, for example, preserved RA function has been shown to improve RV filling and performance, whereas diminished RA function compromises cardiac output. 5,6 Loss of atrial function, in the form of supraventricular arrhythmias with resulting atrioventricular dyssynchrony, is also known to be poorly tolerated among patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH). 7,8 Moreover, animal models have shown that RA systolic function is, in fact, augmented in the setting of RV ischemia and that if there is a subsequent ischemic insult to the RA, RV function is significantly reduced. 7 Taken together, these studies suggest that RA function must not only be maintained but at times augmented, in order to optimize total right heart function in the setting of RV c...

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“…RV systolic function can be assessed by measuring the longitudinal systolic displacement of the RV base toward the RV apex. This is commonly referred to as the tricuspid annular plane systolic excursion (14) and is relatively simple to perform, highly reproducible, and has been shown to correlate well with RV ejection fraction derived from radionuclide angiography (14,15). A normal tricuspid annular plane systolic excursion is about 2.4-2.7 cm (16,17), whereas a value below 1.8 cm has been shown to have an 87% accuracy at predicting a stroke volume index less than 29 ml/m 2 (18).…”

Section: Detection and Monitoring Of Rv Function In Critically Ill Pamentioning

confidence: 99%

Management of Acute Right Ventricular Failure in the Intensive Care Unit

2014

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Right ventricular (RV) failure occurs when the RV fails to maintain enough blood flow through the pulmonary circulation to achieve adequate left ventricular filling. This can occur suddenly in a previously healthy heart due to massive pulmonary embolism or right-sided myocardial infarction, but many cases encountered in the intensive care unit involve worsening of compensated RV failure in the setting of chronic heart and lung disease. Management of RV failure is directed at optimizing right-sided filling pressures and reducing afterload. Due to a lower level of vascular tone, vasoactive medications have less salient effects on reducing vascular resistance in the pulmonary than in the systemic circulation. Successful management requires reversal of any conditions that heighten pulmonary vascular tone and the use of selective pulmonary vasodilators at doses that do not induce systemic hypotension or worsening of oxygenation. Systemic systolic arterial pressure should be kept close to RV systolic pressure to maintain RV perfusion. When these efforts fail, the judicious use of inotropic agents may help improve RV contractility enough to maintain cardiac output. Extracorporeal life support is increasingly being used to support patients with acute RV failure who fail to respond to medical management while the underlying cause of their RV failure is addressed.

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Right Heart Function and Scleroderma: Insights from Tricuspid Annular Plane Systolic Excursion

Abstract: We can predict the rehospitalization rate of SSc patients by TAPSE and RVEF, suggesting the involvement of heart, skin, lung, and other organs in scleroderma patients.

Cited by 60 publications

References 23 publications

Evaluation of TAPSE as a measure of right ventricular output

Evaluation of TAPSE as a measure of right ventricular output

Assessment of the Physiologic Contribution of Right Atrial Function to Total Right Heart Function in Patients with and without Pulmonary Arterial Hypertension

Management of Acute Right Ventricular Failure in the Intensive Care Unit

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