Skip to main content
Log in

Relationship between the tricuspid annular plane systolic excursion and right and left ventricular function in critically ill patients

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

Echocardiographic recording of the tricuspid annular plane systolic excursion (TAPSE) has been recommended for assessing right ventricular function in cardiac patients. The ability of TAPSE to reflect right ventricular function at baseline and to monitor acute changes in right ventricular function was tested in critically ill patients.

Design

Prospective study.

Setting

A 24-bed medical intensive care unit.

Patients

Eighty-six patients admitted for acute respiratory failure, circulatory failure, or coma.

Interventions

In 40 patients, the examination was repeated after volume expansion (n = 15), passive leg raising (n = 5), or dobutamine infusion (n = 20).

Measurements and results

The right ventricular fractional area change, TAPSE, the left ventricular ejection fraction, and the ratio of right to left ventricular end-diastolic area were measured using Doppler echocardiography. In the overall population, TAPSE (19 ± 5 mm) was positively related to left ventricular ejection fraction (r 2 = 0.31, p < 0.001) and right ventricular fractional area change and was negatively related to age and to the ratio of right to left ventricular end-diastolic area. Multivariate analysis indicated that only left ventricular ejection fraction and agewere independently related toTAPSE (multiple r 2 = 0.36, p < 0.001). Following dynamic interventions, the changes in TAPSE were linearly related to changes in left ventricular ejection fraction (r 2 = 0.65, p < 0.01) but notto changes in the right ventricular fractional area change.

Conclusions

Unexpectedly, TAPSE was more strongly related to left ventricular ejection fraction than to indices of right ventricular function in critically ill patients. The potential interest of TAPSE as a dynamic marker of left ventricular systolic function deserves further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Beaulieu Y, Marik PE (2005) Bedside ultrasonography in the ICU: part 1. Chest 128:881–895

    Article  PubMed  Google Scholar 

  2. Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F (2003) Hemodynamic instability in sepsis. Bedside assessment by Doppler echocardiography. Am J Respir Crit Care Med 168:1270–1276

    Article  PubMed  Google Scholar 

  3. Jardin F, Dubourg O, Bourdarias JP (1997) Echocardiographic pattern of acute cor pulmonale. Chest 111:209–217

    PubMed  CAS  Google Scholar 

  4. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, St John Sutton M, Stewart WJ (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  5. Voelkel NF, Quaife RA, Leinwand LA, Barst RJ, McGoon MD, Meldrum DR, Dupuis J, Long CS, Rubin LJ, Smart FW, Suzuki YJ, Galdwin M, Denholm EM, Gail DD (2006) Right ventricular function and failure. Report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure. Circulation 114:1883–1891

    Article  PubMed  Google Scholar 

  6. Rushmer RF, Crystal DK (1951) Changes in configuration of the ventricular chambers during the cardiac cycle. Circulation 4:211–218

    PubMed  CAS  Google Scholar 

  7. Smiley I, Rich S, McLaughlin VV (1992) Cardiology clinics: the right ventricle. WB Saunders, Philadelphia, pp 1–196

    Google Scholar 

  8. Kaul S, Tei C, Hopkins JM, Shah PM (1984) Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 107:526–531

    Article  PubMed  CAS  Google Scholar 

  9. Di Salvo TG, Mathier M, Semigran MJ, Dec GW (1995) Preserved right ventricular ejection fraction predicts exercise capacity and survival in advanced heart failure. J Am Coll Cardiol 25:1143–1153

    Article  PubMed  Google Scholar 

  10. Ghio S, Recusani F, Klersy C, Sebastiani R, Laudisa ML, Campana C, Gavazzi A, Tavazzi L (2000) Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy. Am J Cardiol 85:837–842

    Article  PubMed  CAS  Google Scholar 

  11. Shah AR, Grodman R, Salazar MF, Rehman NU, Coppola J, Braff R (2000) Assessment of right ventricular dysfunction induced by right coronary artery occlusion using echocardiographic atrioventricular plane displacement. Echocardiography 17:513–519

    Article  PubMed  CAS  Google Scholar 

  12. Samad BA, Alam M, Jensen-Urstad K (2002) Prognostic impact of right ventricular involvement as assessed by tricuspid annular motion in patients with acute myocardial infarction. Am J Cardiol 90:778–781

    Article  PubMed  Google Scholar 

  13. Hébert JL, Chemla D, Gérard O, Zamani K, Quillar J, Azarine A, Frank R, Lecarpentier Y, Fontaine G (2004) Angiographic right and left ventricular function in arrhythmogenic right ventricular dysplasia. Am J Cardiol 93:728–733

    Article  PubMed  Google Scholar 

  14. Miller D, Farah MG, Liner A, Fox K, Schluchter M, Hoit BD (2004) The relation between quantitative right ventricular ejection fraction and indices of tricuspid annular motion and myocardial performance. J Am Soc Echocardiogr 17:443–447

    Article  PubMed  Google Scholar 

  15. Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, Chamera E, Corretti MC, Champion HC, Abraham TP, Girgis RE, Hassoun PM (2006). Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med 174:1034–1041

    Article  PubMed  Google Scholar 

  16. Saxena N, Rajagopalan N, Edelman K, Lopez-Candales A (2006) Tricuspid annular systolic velocity: a useful measurement in determining right ventricular systolic function regardless of pulmonary artery pressures. Echocardiography 23:750–755

    Article  PubMed  Google Scholar 

  17. Lopez-Candales A, Rajagopalan N, Saxena N, Gulyasy B, Edelman K, Bazaz R (2006) Right ventricular systolic function is not the sole determinant of tricuspid annular motion. Am J Cardiol 98:973–977

    Article  PubMed  Google Scholar 

  18. Kjaergaard J, Akkan D, Iversen KK, Kober L, Torp-Pedersen C, Hassager C (2007) Right ventricular dysfunction as an independent predictor of short- and long-term mortality in patients with heart failure. Eur J Heart Fail 9:610–616

    Article  PubMed  Google Scholar 

  19. Lamia B, Teboul JL, Monnet X, Richard C, Chemla D (2006) Relation between the tricuspid annulus plane systolic excursion and heart function in ICU patients. Intensive Care Medicine. Abstracts of the 19th Annual Congress of the European Society of Intensive Care Med 32:S35

    Google Scholar 

  20. Slama M, Maizel J (2006) Echocardiographic measurement of ventricular function. Curr Opin Crit Care Med 12:241–248

    Article  Google Scholar 

  21. Poelaert J, Schüpfer G (2005) Hemodynamic monitoring utilizing transesophageal echocardiography. The relationships among pressure, flow and function. Chest 127:379–390

    Article  PubMed  Google Scholar 

  22. Monnet X, Rienzo M, Osman D, Anguel N, Richard C, Pinsky M, Teboul JL (2006) Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med 34:1402–1407

    Article  PubMed  Google Scholar 

  23. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky M, Teboul JL (2000) Relation between respiratory changes in arterial pulse pressure and fluid responsiveness in septic patients with acute circulatory failure. Am J Respir Crit Care Med 162:134–138

    PubMed  CAS  Google Scholar 

  24. Chemla D, Castelain V, Hervé P, Lecarpentier Y, Brimioulle S (2002) Haemodynamic evaluation of pulmonary hypertension. Eur Respir J 20:1314–1331

    Article  PubMed  CAS  Google Scholar 

  25. Vieillard-Baron A, Schmitt JM, Augarde R, Fellahi JL, Prin S, Page B, Beauchet A, Jardin F (2001) Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis. Crit Care Med 29:1551–1555

    Article  PubMed  CAS  Google Scholar 

  26. Santamore WP, Dell'Italia LJ (1998) Ventricular interdependence: significant left ventricular contributions to right ventricular systolic function. Prog Cardiovasc Dis 40:289–308

    Article  PubMed  CAS  Google Scholar 

  27. Robotham JL, Takata M, Berman M, Harasawa Y (1991) Ejection fraction revisited. Anesthesiology 74:172–183

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Denis Chemla.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lamia, B., Teboul, JL., Monnet, X. et al. Relationship between the tricuspid annular plane systolic excursion and right and left ventricular function in critically ill patients. Intensive Care Med 33, 2143–2149 (2007). https://doi.org/10.1007/s00134-007-0881-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-007-0881-y

Keywords

Navigation