Ichimura Kenzo, Celestin Bettia E, Bagherzadeh Shadi P, Zamanian Roham T, Salerno Michael, Spiekerkoetter Edda, Haddad Francois
Department of Medicine, Division of Pulmonary Allergy and Critical Care Stanford University Stanford CA USA.
Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford School of Medicine Stanford University Stanford CA USA.
Pulm Circ. 2024 Sep 6;14(3):e12416. doi: 10.1002/pul2.12416. eCollection 2024 Jul.
Tricuspid annular plane systolic excursion (TAPSE) is usually measured with M-mode using sector line, however, this may not align with the anatomical shortening of the right ventricular (RV). In this study, we compared the different methods to measure TAPSE using three different reference lines (sector line, anatomical line, and apico-annular line). We included 148 patients diagnosed with pulmonary arterial hypertension (PAH) who underwent TTE and right heart catheterization within 2 weeks of each other. TAPSE was measured by M-mode (sector, anatomical), 2D (sector, anatomical), or as tricuspid apico-annular displacement (TAAD). Agreement between measures was assessed using coefficient of variation (COV), Spearman's correlation, and Bland-Altman analysis. Receiver-operating characteristics and Kaplan-Meier analysis were used to explore associations with the combined outcome of death or lung transplantation at 5 years. There was a good concordance between anatomical and sector M-mode with a COV of 15.5 ± 1.6% and a bias of -0.6 ± 3.2 mm. In contrast, anatomical M-mode TAPSE and TAAD differed significantly with the mean difference of 3.3 ± 3.8 mm (COV 30.5 ± 6.1%; < 0.0001). Among the different 2D methods, anatomical 2D agreed well with anatomical M-mode TAPSE (COV of 11.8 ± 2.0%; = 0.89; < 0.0001). Among the five methods, TADD had the strongest association with the combined endpoint of death or transplantation at 5 years (C-statistic 0.64, 95% confidence interval [CI] 0.57-0.71). We concluded that different measures of TAPSE are not interchangeable.
三尖瓣环平面收缩期位移（TAPSE）通常使用M型超声心动图，沿扇区线进行测量，然而，这可能与右心室（RV）的解剖学缩短不一致。在本研究中，我们比较了使用三条不同参考线（扇区线、解剖线和心尖-瓣环线）测量TAPSE的不同方法。我们纳入了148例被诊断为肺动脉高压（PAH）的患者，他们在彼此两周内接受了经胸超声心动图（TTE）和右心导管检查。TAPSE通过M型超声心动图（扇区、解剖）、二维超声心动图（扇区、解剖）进行测量，或作为三尖瓣心尖-瓣环位移（TAAD）进行测量。使用变异系数（COV）、Spearman相关性和Bland-Altman分析评估测量值之间的一致性。使用受试者操作特征和Kaplan-Meier分析来探索与5年时死亡或肺移植联合结局的关联。解剖M型超声心动图和扇区M型超声心动图之间具有良好的一致性，COV为15.5±1.6%，偏差为-0.6±3.2mm。相比之下，解剖M型超声心动图TAPSE和TAAD存在显著差异，平均差异为3.3±3.8mm（COV 30.5±6.1%；P<0.0001）。在不同的二维方法中，解剖二维超声心动图与解剖M型超声心动图TAPSE一致性良好（COV为11.8±2.0%；r=0.89；P<0.0001）。在这五种方法中，TAAD与5年时死亡或移植联合终点的关联最强（C统计量0.64，95%置信区间[CI]0.57-0.71）。我们得出结论，TAPSE的不同测量方法不可互换。
