Zornitzki Lior, Freund Ophir, Frydman Shir, Rozenbaum Zach, Granot Yoav, Banai Shmuel, Topilsky Yan
Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel.
School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Internal Medicine B, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
J Am Soc Echocardiogr. 2025 Mar;38(3):228-235. doi: 10.1016/j.echo.2024.10.012. Epub 2024 Oct 30.
Tricuspid annular plane systolic excursion (TAPSE) and peak lateral tricuspid annular systolic velocity (S') are echocardiographic indices of right ventricle function. The abnormality thresholds for these parameters are based on data obtained from healthy adults rather than outcome data.
We aimed to reexamine the abnormality thresholds for these parameters based on their association with mortality in consecutive patients, stratified to with or without significant tricuspid regurgitation (TR).
We performed a retrospective analysis of consecutive patients undergoing echocardiography between 2011 and 2021. Tricuspid regurgitation was assessed using a semiquantitative method. Cutoff values associated with excess mortality were assessed using spline curves in univariate and multivariate Cox analyses.
A total of 24,717 subjects were included in the current analysis. A total of 1,143 (4.6%) subjects had clinically significant (moderate or more) TR. In the entire cohort, TAPSE <20.9 mm and S' <10.9 cm/sec were associated with excess mortality. In subgroup analysis, among subjects with significant TR, TAPSE <18.0 mm and S' <10.0 cm/sec were the cutoffs associated with excess mortality, while subjects without TR had a higher cutoff of TAPSE <21.5 mm and S' <10.9 cm/sec. In a multivariate model adjusted for the presence of TR and baseline characteristics, TAPSE <20.9 mm (hazard ratio = 1.16; 95% CI, 1.10-1.23; P < .001) and S' <10.9 cm/sec (hazard ratio =1.09; 95% CI, 1.04-1.20; P = .01) were independently associated with mortality.
The TAPSE and S' thresholds associated with excess mortality are higher than those reported in healthy adults. The TAPSE and S' cutoffs associated with excess mortality were lower in patients with significant TR compared to patients without, suggesting that a personalized approach for their interpretation is needed.
三尖瓣环平面收缩期位移（TAPSE）和三尖瓣环侧壁峰值收缩速度（S'）是右心室功能的超声心动图指标。这些参数的异常阈值是基于从健康成年人获得的数据，而非预后数据。
我们旨在根据这些参数与连续患者死亡率的关联，重新审视这些参数的异常阈值，并按有无显著三尖瓣反流（TR）进行分层。
我们对2011年至2021年间接受超声心动图检查的连续患者进行了回顾性分析。使用半定量方法评估三尖瓣反流。在单变量和多变量Cox分析中，使用样条曲线评估与过高死亡率相关的临界值。
本分析共纳入24717名受试者。共有1143名（4.6%）受试者有临床显著（中度或更严重）TR。在整个队列中，TAPSE<20.9mm和S'<10.9cm/秒与过高死亡率相关。在亚组分析中，在有显著TR 的受试者中，TAPSE<18.0mm和S'<10.0cm/秒是与过高死亡率相关的临界值，而无TR的受试者有更高的临界值，即TAPSE<21.5mm和S'<10.9cm/秒。在针对TR的存在和基线特征进行校正的多变量模型中，TAPSE<20.9mm（风险比=1.16；95%CI，1.10-1.23；P<.001）和S'<10.9cm/秒（风险比=1.
