Zhao Hang, Kang Yu, Pickle Jacob, Wang Jing, Han Yuchi
Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Echocardiography. 2019 Aug;36(8):1459-1466. doi: 10.1111/echo.14439. Epub 2019 Aug 7.
Tricuspid annular plane systolic excursion (TAPSE) is an effective parameter for assessing right ventricular (RV) function in echocardiographic studies. The preload dependency of TASPE has not been explored.
We retrospectively reviewed 380 cardiac magnetic resonance (CMR) exams. RV ejection fraction (EF) and end-diastolic volume (EDV) were measured from short-axis cine images. TAPSE was measured as the difference of the perpendicular distance of the tricuspid annulus to the RV apex during diastole and systole. RV dysfunction was defined as RVEF <47%. The relationship of TAPSE, RVEF, and indexed RVEDV (RVEDVi) were evaluated. The TAPSE cut-off values derived from CMR were tested in a validation group (n = 46) with an echocardiographic exam performed within 1 month of the CMR.
TAPSE had a good linear correlation with RVEF (r = .69, P < .001). In normal RVEF patients, TAPSE had a positive correlation with RVEDVi (r = .208, P = .014). Receiver operating characteristic analysis revealed a higher TAPSE cut-off value of 2.4 cm in the top normal to mildly dilated RV volume group for identifying RV dysfunction with lower predictive accuracy (sensitivity 80%, specificity 67%, area under the curve = 0.78, P < .001) as compared with 2.0 cm for the normal RV size or moderate to severely dilated RV groups. The higher TAPSE cutoff showed improved sensitivity (73% vs 43%) and Youden index (0.55 vs 0.43) in our validation cohort.
Tricuspid annular plane systolic excursion not only correlates with RVEF, but also is dependent on RV volume. The cut-off value and predictive accuracy of TAPSE for detecting RV dysfunction vary with different RV volumes.
三尖瓣环平面收缩期位移（TAPSE）是超声心动图研究中评估右心室（RV）功能的有效参数。尚未探讨TASPE的前负荷依赖性。
我们回顾性分析了380例心脏磁共振（CMR）检查。从短轴电影图像测量右室射血分数（EF）和舒张末期容积（EDV）。TAPSE测量为舒张期和收缩期三尖瓣环到右室心尖垂直距离的差值。右室功能不全定义为右室射血分数<47%。评估TAPSE、右室射血分数和右室舒张末期容积指数（RVEDVi）之间的关系。在CMR检查后1个月内进行超声心动图检查的验证组（n = 46）中测试从CMR得出的TAPSE截断值。
TAPSE与右室射血分数具有良好的线性相关性（r = 0.69，P < 0.001）。在右室射血分数正常的患者中，TAPSE与RVEDVi呈正相关（r = 0.208，P = 0.014）。受试者工作特征分析显示，在正常至轻度扩张的右室容积组中，用于识别右室功能不全的TAPSE截断值较高，为2.4 cm，预测准确性较低（敏感性80%，特异性67%，曲线下面积 = 0.78，P < 0.001），而正常右室大小或中度至重度扩张右室组为2.0 cm。在我们的验证队列中，较高的TAPSE截断值显示出更高的敏感性（73%对43%）和约登指数（0.55对0.43）。
三尖瓣环平面收缩期位移不仅与右室射血分数相关，还依赖于右室容积。TAPSE检测右室功能不全的截断值和预测准确性因右室容积不同而有所差异。
