Tricuspid annular plane systolic excursion is dependent on right ventricular volume in addition to function.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.