Abstract
Tricuspid annular plane systolic excursion (TAPSE) reflects longitudinal myocardial shortening, the main component of right ventricular (RV) contraction in normal hearts. To date, TAPSE has not been extensively studied in patients with hypoplastic left heart syndrome (HLHS) and systemic RVs after Fontan palliation. This retrospective study investigated HLHS patients after Fontan with cardiac magnetic resonance (CMR) performed between 1 January 2010 and 1 August 2012 and transthoracic echocardiogram (TTE) performed within 6 months of CMR. The maximal apical displacement of the lateral tricuspid valve annulus was measured on CMR (using four-chamber cine images) and on TTE (using two-dimensional apical views). To create TTE–TAPSE z-scores, published reference data were used. Intra- and interobserver variability was tested with analysis of variance. Inter-technique agreement of TTE and CMR was tested with Bland–Altman analysis. In this study, 30 CMRs and TTEs from 29 patients were analyzed. The age at CMR was 14.1 ± 7.1 years, performed 11.9 ± 7.8 years after Fontan. For CMR–TAPSE, the intraclass correlation coefficients for inter- and intraobserver variability were 0.89 and 0.91, respectively. The TAPSE measurements were 0.57 ± 0.2 cm on CMR and 0.70 ± 0.2 cm on TTE (TTE–TAPSE z score, −8.7 ± 1.0). The mean difference in TAPSE between CMR and TTE was −0.13 cm [95 % confidence interval (CI) −0.21 to −0.05], with 95 % limits of agreement (−0.55 to 0.29 cm). The study showed no association between CMR–TAPSE and RVEF (R = 0.08; p = 0.67). In patients with HLHS after Fontan, TAPSE is reproducible on CMR and TTE, with good agreement between the two imaging methods. Diminished TAPSE suggests impaired longitudinal shortening in the systemic RV. However, TAPSE is not a surrogate for RVEF in this study population.
Similar content being viewed by others
References
Becker M, Humpel C, Ocklenburg C, Muehler E, Schroeder J, Eickholt C, Hoffmann R, Marx N, Franke A (2010) The right ventricular response to high afterload: comparison between healthy persons and patients with transposition of the great arteries: a 2D strain study. Echocardiography 27:1256–1262
Brown SB, Raina A, Katz D, Szerlip M, Wiegers SE, Forfia PR (2011) Longitudinal shortening accounts for the majority of right ventricular contraction and improves after pulmonary vasodilator therapy in normal subjects and patients with pulmonary arterial hypertension. Chest 140:27–33
Caudron J, Fares J, Vivier PH, Lefebvre V, Petitjean C, Dacher JN (2011) Diagnostic accuracy and variability of three semi-quantitative methods for assessing right ventricular systolic function from cardiac MRI in patients with acquired heart disease. Eur Radiol 21:2111–2120
De Caro E, Bondanza S, Calevo MG, Trocchio G, Lupi G, Domenicucci S, Marasini M (2013) Tricuspid annular plane systolic excursion for the assessment of ventricular function in adults operated on with mustard procedure for complete transposition of the great arteries. Congenit Heart Dis. doi:10.1111/chd.12135
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
Hammarstrom E, Wranne B, Pinto FJ, Puryear J, Popp RL (1991) Tricuspid annular motion. J Am Soc Echocardiogr 4:131–139
Iriart X, Horovitz A, van Geldorp IE, Barnetche T, Lederlin M, De Guillebon M, Reant P, Lafitte S, Thambo JB (2012) The role of echocardiography in the assessment of right ventricular systolic function in patients with transposition of the great arteries and atrial redirection. Arch Cardiovasc Dis 105:432–441
Kalogeropoulos AP, Deka A, Border W, Pernetz MA, Georgiopoulou VV, Kiani J, McConnell M, Lerakis S, Butler J, Martin RP, Book WM (2012) Right ventricular function with standard and speckle-tracking echocardiography and clinical events in adults with D-transposition of the great arteries post atrial switch. J Am Soc Echocardiogr 25:304–312
Kasnar-Samprec J, Kuhn A, Horer J, Vogt M, Cleuziou J, Lange R, Schreiber C (2012) Unloading of right ventricle by bidirectional superior cavopulmonary anastomosis in hypoplastic left heart syndrome patients promotes remodeling of systemic right ventricle but does not improve tricuspid regurgitation. J Thorac Cardiovasc Surg 144:1102–1108
Kaul S, Tei C, Hopkins JM, Shah PM (1984) Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J 107:526–531
Khoo NS, Smallhorn JF, Kaneko S, Myers K, Kutty S, Tham EB (2011) Novel insights into RV adaptation and function in hypoplastic left heart syndrome between the first 2 stages of surgical palliation. JACC Cardiovasc Imaging 4:128–137
Koestenberger M (2012) Transthoracic echocardiography in children and young adults with congenital heart disease. ISRN Pediatr.doi: 10.5402/2012/753481
Koestenberger M, Ravekes W, Everett AD, Stueger HP, Heinzl B, Gamillscheg A, Cvirn G, Boysen A, Fandl A, Nagel B (2009) Right ventricular function in infants, children, and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z-score values. J Am Soc Echocardiogr 22:715–719
Koestenberger M, Nagel B, Ravekes W, Everett AD, Stueger HP, Heinzl B, Sorantin E, Cvirn G, Gamillscheg A (2011) Tricuspid annular plane systolic excursion and right ventricular ejection fraction in pediatric and adolescent patients with tetralogy of Fallot, patients with atrial septal defect, and age-matched normal subjects. Clin Res Cardiol 100:67–75
Koestenberger M, Nagel B, Ravekes W, Everett AD, Stueger HP, Heinzl B, Sorantin E, Cvirn G, Fritsch P, Gamillscheg A (2011) Systolic right ventricular function in pediatric and adolescent patients with tetralogy of Fallot: echocardiography versus magnetic resonance imaging. J Am Soc Echocardiogr 24:45–52
Koestenberger M, Nagel B, Avian A, Ravekes W, Sorantin E, Cvirn G, Beran E, Halb V, Gamillscheg A (2012) Systolic right ventricular function in children and young adults with pulmonary artery hypertension secondary to congenital heart disease and tetralogy of Fallot: tricuspid annular plane systolic excursion (TAPSE) and magnetic resonance imaging data. Congenit Heart Dis 7:250–258
Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, Lai WW, Geva T (2010) Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 23:465–495
Mercer-Rosa L, Parnell A, Forfia PR, Yang W, Goldmuntz E, Kawut SM (2013) Tricuspid annular plane systolic excursion in the assessment of right ventricular function in children and adolescents after repair of tetralogy of Fallot. J Am Soc Echocardiogr 26:1322–1329
Morcos P, Vick GW III, Sahn DJ, Jerosch-Herold M, Shurman A, Sheehan FH (2009) Correlation of right ventricular ejection fraction and tricuspid annular plane systolic excursion in tetralogy of Fallot by magnetic resonance imaging. Int J Cardiovasc Imaging 25:263–270
Nijveldt R, Germans T, McCann GP, Beek AM, van Rossum AC (2008) Semi-quantitative assessment of right ventricular function in comparison to a 3D volumetric approach: a cardiovascular magnetic resonance study. Eur Radiol 18:2399–2405
Petko C, Moller P, Hoffmann U, Kramer HH, Uebing A (2011) Comprehensive evaluation of right ventricular function in children with different anatomical subtypes of hypoplastic left heart syndrome after Fontan surgery. Int J Cardiol 150:45–49
Petko C, Uebing A, Furck A, Rickers C, Scheewe J, Kramer HH (2011) Changes of right ventricular function and longitudinal deformation in children with hypoplastic left heart syndrome before and after the Norwood operation. J Am Soc Echocardiogr 24:1226–1232
Pettersen E, Helle-Valle T, Edvardsen T, Lindberg H, Smith HJ, Smevik B, Smiseth OA, Andersen K (2007) Contraction pattern of the systemic right ventricle shift from longitudinal to circumferential shortening and absent global ventricular torsion. J Am Coll Cardiol 49:2450–2456
Robbers-Visser D, Boersma E, Helbing WA (2009) Normal biventricular function, volumes, and mass in children aged 8 to 17 years. J Magn Reson Imaging 29:552–559
Sarikouch S, Peters B, Gutberlet M, Leismann B, Kelter-Kloepping A, Koerperich H, Kuehne T, Beerbaum P (2010) Sex-specific pediatric percentiles for ventricular size and mass as reference values for cardiac MRI: assessment by steady-state free-precession and phase-contrast MRI flow. Circ Cardiovasc Imaging 3:65–76
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
Sheehan F, Redington A (2008) The right ventricle: anatomy, physiology, and clinical imaging. Heart 94:1510–1515
Speiser U, Hirschberger M, Pilz G, Heer T, Sievers B, Strasser RH, Schoen S (2012) Tricuspid annular plane systolic excursion assessed using MRI for semi-quantification of right ventricular ejection fraction. Br J Radiol 85:e716–e721
Acknowledgments
Dr. Avitabile is supported by NIH T32 HL007915. Dr. Mercer-Rosa is supported by 3U01HL098153-03S1.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Avitabile, C.M., Whitehead, K., Fogel, M. et al. Tricuspid Annular Plane Systolic Excursion Does Not Correlate With Right Ventricular Ejection Fraction in Patients With Hypoplastic Left Heart Syndrome After Fontan Palliation. Pediatr Cardiol 35, 1253–1258 (2014). https://doi.org/10.1007/s00246-014-0924-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-014-0924-4