Tricuspid Annular Plane Systolic Excursion in the Assessment of Right Ventricular Function in Children and Adolescents after Repair of Tetralogy of Fallot

Abstract

Background Assessing right ventricular (RV) performance is essential for patients with tetralogy of Fallot (TOF). The aim of this study was to investigate the reliability and validity of tricuspid annular plane systolic excursion (TAPSE) against cardiac magnetic resonance imaging measures and cardiopulmonary exercise testing. Methods A retrospective study was performed in 125 outpatients with repaired TOF with available protocoldriven echocardiography, cardiac magnetic resonance imaging, and exercise stress testing obtained as part of a cross-sectional study. TAPSE was measured on the two-dimensional apical four-chamber view on echocardiography by two readers. Multivariate linear regression was used to examine the association between TAPSE and measures of RV function and exercise capacity. Results The mean age was 12.6 ± 3.3 years, 41 patients (33%) were female, and 104 (83%) were white. TAPSE averaged 1.6 ± 0.37 cm, with an interreader intraclass correlation coefficient of 0.78 (n = 18). TAPSE was significantly associated with cardiac magnetic resonance–based RV stroke volume after adjustment for gender and body surface area (β = 13.8; 95% confidence interval, 2.25–25.30; P = .02). TAPSE was not associated with cardiac magnetic resonance–based RV ejection fraction (P = .77). On exercise testing, TAPSE was not associated with peak oxygen consumption, percentage of predicted oxygen consumption, oxygen pulse, or the ventilatory equivalent for carbon dioxide in patients with maximal exercise stress testing (n = 73 [58%]). Conclusions TAPSE is reproducibly measured by echocardiography in patients with TOF. It is not associated with RV ejection fraction or exercise performance, and its association with RV stroke volume may be confounded by body size. On the basis of these results, TAPSE is not representative of global RV performance in patients with TOF.

Tricuspid Annular Plane Systolic Excursion Does Not Correlate With Right Ventricular Ejection Fraction in Patients With Hypoplastic Left Heart Syndrome After Fontan Palliation

“…We measured TTE–TAPSE “offline” from the apical four-chamber two-dimensional view because M-mode TAPSE was not yet part of our laboratory’s standard echocardiography protocol when the images were obtained. However, as we have previously shown, the TAPSE values obtained by the two TTE methods show minimal difference [18]. Given the cross-sectional design of the study, it is unknown whether TAPSE changes with the stages of single-ventricle palliation and whether decreased TAPSE has prognostic implications.…”

“…This technique was shown to be similar to measurement of the distance by M-mode [18]. Three TTE–TAPSE measurements were averaged for each patient.…”

Postsystolic Shortening Is Associated with Altered Right Ventricular Function in Children after Tetralogy of Fallot Surgical Repair

“…A negative correlation between PSSTi duration and TAPSE, in our circumstances, most likely confirms local contractile dysfunction in the basal lateral segment of the right ventricle where the parameter is typically measured. According to the trials TAPSE does not reflect global systolic function in children after TOF correction [22]. …”

Diagnosing and treating the failing right heart

“…TAPSE has been shown to correlate with outcomes in multiple cohorts of patients with PAH[2,27] and LV failure. [4-6] However, other data suggests changes in TAPSE may not be reliable marker of disease progression[28] and may also not represent global RV function in congenital heart disease[29] or after cardiac surgery. [30] After cardiac surgery, longitudinal shortening is depressed – from acquired septal dysfunction[31] and/or loss of pericardial constraint[32] - and the RV becomes more dependent on transverse shortening by the RV free wall.…”