Determinants of reduced tricuspid annular plane systolic excursion in patients with severe systolic left ventricular dysfunction.

OBJECTIVE: Right ventricular (RV) dysfunction is associated with poor exercise tolerance and prognosis, regardless of left ventricular (LV) function. Tricuspid annular plane systolic excursion (TAPSE) is a non-invasive parameter of RV longitudinal function which can predict outcome in heart failure (HF) patients (pts). Our aim was to investigate the relation of TAPSE to clinical and echocardiographic parameters in severe LV dysfunction.

METHODS AND RESULTS: The study included 119 pts with non-ischaemic dilated cardiomyopathy (n = 46) and ischaemic heart disease (n = 73) in stable HF with severe LV systolic dysfunction (LV ejection fraction (EF) < 30%). In pts with different LV dysfunction severity the higher NYHA class correlated with lower TAPSE dimensions: NYHA class IV 12.7 +/- 2.9 mm vs. NYHA class III 15.9 +/- 4.2 mm and NYHA class II 18.8 +/- 4.2 mm, P < 0.001. The presence of atrial arrhythmias in 16% of pts was related to lower values of TAPSE (12.9 +/- 3.6 mm vs. 15.4 +/- 4.2 mm, P < 0.05). Pts with non-ischaemic HF aetiology were found to have lower values of TAPSE compared to ischaemic aetiology (12.5 +/- 2.8 mm vs. 16.6 +/- 4.1 mm, P = 0.001) and increased odds of low TAPSE (< or = 14 mm)--odds ratio (OR) [95% confidence interval] = 9.8 [3.8-25.6], P < 0.001. Multivariate analysis revealed that LVEF, deceleration time (DT) of early mitral inflow E wave and the RV end-diastolic diameter are independent determinants of reduced TAPSE (< or = 14 mm) in pts with severe LV systolic dysfunction.

CONCLUSION: The lower TAPSE values are related to higher NYHA functional class, presence of atrial arrhythmias and non-ischaemic aetiology in HF pts. The LVEF, DT of LV filling and RV end-diastolic diameter are independent predictors of reduced TAPSE (< or = 14 mm) in pts with severe systolic LV dysfunction.