Evaluation of right ventricular systolic function by the analysis of tricuspid annular motion in patients with acute pulmonary embolism

Jae-Hyeong Park, Jun Hyung Kim, Jae-Hwan Lee, Si Wan Choi, Jin-Ok Jeong, In-Whan Seong
Journal of Cardiovascular Ultrasound 2012, 20 (4): 181-8

BACKGROUND: Measurement of right ventricular (RV) systolic function is important for patients with acute pulmonary embolism (PE). However, assessment of RV function is a challenge due to its complex anatomy. We measured RV systolic function with analysis of tricuspid annular motion in acute PE patients.

METHODS: From August 2007 to May 2011, all consecutive PE patients were prospectively included. Tricuspid annular motion was analyzed with tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV).

RESULTS: We analyzed total 50 patients (38 females, 68 ± 14 years). Mean RV fractional area change (RVFAC) was 26.2 ± 10.8%; RV Tei index 0.78 ± 0.35; TR Vmax 3.8 ± 0.5 m/sec; pulmonary vascular resistance (PVR) 3.5 ± 1.2 WU. TAPSE was 16 ± 4 mm and TASV was 11.7 ± 4.0 cm/sec. TAPSE showed significant correlations with RVFAC (r = 0.841, p < 0.001), RV Tei index (r = -0.347, p = 0.018), Log B-type natriuretic peptide (BNP) (r = -0.634, p < 0.001) and PVR (r = -0.635, p < 0.001). TASV also revealed significant correlations with RVFAC (r = 0.605, p < 0.001), RV Tei index (r = -0.380, p = 0.009), LogBNP (r = -0.477, p = 0.001) and PVR (r = -0.483, p = 0.001). The best cutoff of TAPSE for detection of RV systolic dysfunction (defined as RVFAC < 35%) was 1.75 cm [Areas under the curve (AUC) = 0.96, p < 0.001] with a sensitivity of 87% and specificity 91%. The best cutoff for TASV was 13.8 cm/sec (AUC = 0.90, p < 0.001), sensitivity 86% and specificity 78%. However, there was no statistical significance in the detection of RV dysfunction (difference = 0.07, 95% CI = -0.21-0.17, p = 0.130) between TAPSE and TASV.

CONCLUSION: TAPSE and TASV showed significant correlations with conventional echocardiographic parameters of RV function and LogBNP value. These values can be used to detect RV systolic dysfunction more easily in patients with acute PE.

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