Tricuspid Annular Systolic Velocity: A Useful Measurement in Determining Right Ventricular Systolic Function Regardless of Pulmonary Artery Pressures

Abstract

Assessment of right ventricular (RV) systolic function can be somewhat difficult, particularly in pulmonary hypertension (PH). RV fractional area change (FAC) and tricuspid valve annular motion (TAPSE) although useful in the assessment of RV performance, their use can be sometimes limited and tedious. Thus, a quicker but yet reliable alternative is needed. Accordingly, we compared peak tricuspid annulus systolic (TA Sa) velocities derived from Doppler tissue imaging (DTI) with both RVFAC and TAPSE to estimate RV function in 52 patients (53 +/- 16 years) with varying degrees of PH. In this group, mean was RVFAC 49 +/- 20, TAPSE was 2.3 +/- 0.7 cm, peak TA Sa velocity by DTI was 10.4 +/- 3.8 cm/s, left ventricular systolic function was 57 +/- 18%, and pulmonary artery systolic pressure was 47 +/- 28 mmHg. An excellent correlation was noted between TAPSE and RVFAC (r = 0.91, P < 0.001). Similar correlations were noted between peak TA Sa velocity and RVFAC (r = 0.84, P < 0.001) and between peak TA Sa velocity and TAPSE (r = 0.90, P < 0.001). A TA Sa >10.5 cm/s identified individuals with both a normal RV function and without significant PH. Therefore, we conclude that TA Sa velocity, an easily obtainable DTI measure, that has an excellent correlation with more time-consuming methods to assess RV systolic function regardless of the degree of PH should be routinely assessed during the initial evaluation and eventual follow-up of patients either at risk or with documented PH.

Evaluation of TAPSE as a measure of right ventricular output

“…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.…”

Induction of anesthesia does not alter tricuspid annular velocities: a tissue Doppler assessment

“…Tricuspid annular descent or TAPSE has been shown to correlate with RV FAC, but is influenced by LV function. 4,5,7 Values above 20 mm have been associated with normal biventricular function. 5 The pre-ejection period has also been used to assess right-heart function using variables such as dP/dt.…”

“…5,6 Tricuspid annular or myocardial velocities (TAV) have also been used to assess RV function. 7,8 The isovolemic acceleration (IVA) has been shown to be a load-independent measure of contractility. 9 The systolic ejection velocity has compared favourably with other measures of RV function but remains a more loaddependent measure of contractility.…”

Risk Factors for Late Right Ventricular Systolic Dysfunction in Pediatric Patients With Repaired Tetralogy of Fallot

“…Previous studies reported that a TAPSV < 11.5 cm/s or < 10.5 cm/s was able to predict impaired right ventricular systolic function. 5,13) A similar cutoff (TAPSV < 10.8 cm/s) was found in adults as a predictor of 14)…”