Simple prediction of right ventricular ejection fraction using tricuspid annular plane systolic excursion in pulmonary hypertension

Sato, Takahiro; Tsujino, Ichizo; Oyama‐Manabe, Noriko; Ohira, Hiroshi; Ito, Yoichi M.; Sugimori, Hiroyuki; Yamada, Asuka; Takashina, Chisa; Watanabe, Taku; Nishimura, Masaharu

doi:10.1007/s10554-013-0286-7

Cited by 35 publications

(26 citation statements)

References 19 publications

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“…13,24 However, the prognostic value of RV assessment among patients with lung-PH has not been addressed. In this study, patients with severe lung-PH had increased RVEDVI and reduced RVEF at baseline, compared with previously reported normal values, 18,19 and therapy with PAH-approved drugs over 3 months significantly decreased the RVEDVI (by 23.7%) and increased the RVEF (by 32.9%). Importantly, there were no significant changes in the WHO FC, whereas 6MWD and serum BNP levels improved significantly at the 3-month follow-up.…”

Section: Discussionsupporting

confidence: 56%

The Effects of Pulmonary Vasodilating Agents on Right Ventricular Parameters in Severe Group 3 Pulmonary Hypertension: A Pilot Study

et al. 2016

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Pulmonary arterial hypertension (PAH)-approved vasodilators improve right ventricular (RV) function in patients with PAH. However, whether PAH-approved drugs ameliorate RV morphology and function in lung disease-associated pulmonary hypertension (lung-PH) remains unclear. We aimed to prospectively evaluate the changes in RV volume and ejection fraction (RVEF) in 14 consecutive severe lung-PH patients treated with PAH-approved vasodilators. Severe lung-PH was defined as a mean pulmonary arterial pressure (MPAP) of ≥35 mmHg or an MPAP of ≥25 mmHg with a cardiac index (L/min/m 2 ) of <2. Right heart catheterization and cardiac magnetic resonance (CMR) imaging were performed at baseline and at 3 months after starting sildenafil with or without other PAH-approved drugs. Follow-up was conducted at 3 months in 11 participants; compared with baseline values, MPAP and pulmonary vascular resistance (PVR) decreased by 18% and 37%, respectively. Baseline CMR imaging revealed an elevated RV end-diastolic volume index (RVEDVI; mL/m 2 ) of 117.5 ± 35.9 and a below-average RVEF of 25.2% ± 7.2%; after 3 months, RVEDVI decreased by 23.7% (P = 0.0061) and RVEF increased by 32.9% (P = 0.0165). Among the 11 patients, 3 were thought to be a stable and homogenous subset in terms of background lung disease and medical management administered. These 3 patients exhibited similar ameliorations in PVR and RVEF, compared with the other 8 patients. PAH-approved drug treatment may improve RV dilatation and systolic function among patients with severe lung-PH. This study was approved by University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) on September 1, 2013 (UMIN000011541).

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Section: Discussionsupporting

confidence: 56%

The Effects of Pulmonary Vasodilating Agents on Right Ventricular Parameters in Severe Group 3 Pulmonary Hypertension: A Pilot Study

et al. 2016

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“…Prior work has shown that, in particular, longitudinal measures of RV function, including TAPSE, improve in response to PH medical therapy 22,27 with a TAPSE of ≥ 2 cm on serial CMRI, highly predictive of a preserved RVEF. 18 Taken together, these findings make a TAPSE cut-point ≥ 2 cm a rational choice as a serial echocardiographic measure of normal RV function in response to therapy. 17,18 …”

Section: Discussionmentioning

confidence: 96%

“…18 Taken together, these findings make a TAPSE cut-point ≥ 2 cm a rational choice as a serial echocardiographic measure of normal RV function in response to therapy. 17,18 …”

Section: Discussionmentioning

confidence: 96%

“…To date, no study has evaluated the utility of follow-up TAPSE assessment, as opposed to baseline TAPSE measurement, in predicting survival in a PAH population, after initiation of PAH therapy. Thus, we sought to assess the prognostic role of follow-up TAPSE measurement, and specifically a treatment TAPSE goal of ≥2 cm, as previously proposed 17 and reflective of normal RV function, 18 in a PAH population after initiation of PAH therapy.…”

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confidence: 99%

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Follow‐up tricuspid annular plane systolic excursion predicts survival in pulmonary arterial hypertension

et al. 2017

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Few studies have examined the utility of serial echocardiography in the evaluation, management, and prognosis of patients with pulmonary arterial hypertension (PAH). Therefore, we sought to evaluate the prognostic significance of follow-up tricuspid annular plane systolic excursion (TAPSE) in PAH. We prospectively studied 70 consecutive patients with PAH who underwent baseline right heart catheterization (RHC) and transthoracic echocardiogram, who survived to follow-up echocardiogram after initiation of PAH therapy. Baseline TAPSE was 1.6 ± 0.5 cm which increased to 2.0 ± 0.4 cm on follow-up (P < 0.0001). The cohort was dichotomized by TAPSE at one-year follow-up: Group 1 (n = 37): follow-up TAPSE ≥ 2 cm; Group 2 (n = 33): follow-up TAPSE < 2 cm. Group 1 participants were significantly more likely to reach WHO functional class I–II status and achieve a higher six-minute walk distance on follow-up. Of the 68 patients who survived more than one year, 18 died (26.5%) over a median follow-up of 941 days (range, 3–2311 days), with significantly higher mortality in Group 2 versus Group 1 (41.9% vs. 13.5%; P = 0.003). While baseline TAPSE stratified at 2 cm did not predict survival in this cohort, TAPSE ≥ 2 cm at follow-up strongly predicted survival in bivariable models (hazard ratio, 0.21; 95% confidence interval, 0.08–0.60). In conclusion, follow-up TAPSE ≥ 2 cm is a prognostic marker and potential treatment target in a PAH population.

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“…There are, however, contradictory conclusions in the literature how well TTE-derived TAPSE correlates to CMR-derived RVEF. There are examples where the correlation between TAPSE and RVEF varies from no correlation [9, 10] to statistically significant correlation (range 0.45-0.86) [11–13]. Recent guidelines for echocardiography still recommend RV assessment by 2D TTE using multiple acoustic windows, while 3D TTE is only recommended for laboratories with experience in this area [14].…”

Section: Introductionmentioning

confidence: 99%

Right ventricular ejection fraction measurements using two-dimensional transthoracic echocardiography by applying an ellipsoid model

Jorstig

Waldenborg

Lidén

et al. 2017

Cardiovasc Ultrasound

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BackgroundThere is today no established approach to estimate right ventricular ejection fraction (RVEF) using 2D transthoracic echocardiography (TTE). The aim of this study was to evaluate a new method for RVEF calculations using 2D TTE and compare the results with cardiac magnetic resonance (CMR) imaging and tricuspid annular plane systolic excursion (TAPSE).MethodsA total of 37 subjects, 25 retrospectively included patients and twelve healthy volunteers, were included to give a wide range of RVEF. The right ventricle (RV) was modeled as a part of an ellipsoid enabling calculation of the RV volume by combining three distance measurements. RVEF calculated according to the model, RVEFTTE, were compared with reference CMR-derived RVEF, RVEFCMR. Further, TAPSE was measured in the TTE images and the correlations were calculated between RVEFTTE, TAPSE and RVEFCMR.ResultsThe mean values were RVEFCMR = 43 ± 12% (range 20–66%) and RVEFTTE = 50 ± 9% (range 34–65%). There was a high correlation (r = 0.80, p < 0.001) between RVEFTTE and RVEFCMR. Bland-Altman analysis showed a mean difference between RVEFCMR and RVEFTTE of 6 percentage points (ppt) with limits of agreement from −11 to 23 ppt. The mean value for TAPSE was 19 ± 5 mm and the correlation between TAPSE and RVEFCMR was moderate (r = 0.54, p < 0.001). The correlation between RVEFTTE and RVEFCMR was significantly higher (p < 0.05) than the correlation between TAPSE and RVEFCMR.ConclusionsThe ellipsoid model shows promise for RVEF calculations using 2D TTE for a wide range of RVEF, providing RVEF estimates that were significantly better correlated to RVEF obtained from CMR compared to TAPSE.Electronic supplementary materialThe online version of this article (doi:10.1186/s12947-017-0096-5) contains supplementary material, which is available to authorized users.

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Simple prediction of right ventricular ejection fraction using tricuspid annular plane systolic excursion in pulmonary hypertension

Cited by 35 publications

References 19 publications

The Effects of Pulmonary Vasodilating Agents on Right Ventricular Parameters in Severe Group 3 Pulmonary Hypertension: A Pilot Study

The Effects of Pulmonary Vasodilating Agents on Right Ventricular Parameters in Severe Group 3 Pulmonary Hypertension: A Pilot Study

Follow‐up tricuspid annular plane systolic excursion predicts survival in pulmonary arterial hypertension

Right ventricular ejection fraction measurements using two-dimensional transthoracic echocardiography by applying an ellipsoid model

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