Introduction
Advanced tricuspid regurgitation is a heart valve disease where the flaps of the heart valve do not close properly. In such patients, the blood flow is not regulated. It is also associated with pulmonary hypertension and right ventricular dysfunction. The patients undergoing valve surgery with a previous history of cardiac surgery results in poor prognosis. This is due to the difficulty to find out the best time for surgery and also to assess the right ventricular function. In such a situation, the tricuspid annular plane systolic excursion is important.
What Is Tricuspid Annular Plane Systolic Excursion?
It is a scoring system to determine the right ventricular function of the heart. It is used along with non-invasive Doppler echocardiography. It is a simple, reproducible parameter to quantitatively assess the right ventricular ejection fraction. Assessing the right ventricular function in patients with heart failure is important. TAPSE has been recommended in the recent joint American European Guidelines for echocardiographic quantification of right ventricular function.
It can predict the possible outcome in patients undergoing heart valve surgery with a previous history of cardiac surgery. TAPSE can be used for the assessment of the following.
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Congestive heart failure.
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Pulmonary arterial hypertension.
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Non-ischemic cardiomyopathy.
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Congenital heart defects like tetralogy of Fallot.
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Right ventricular dysfunction in heart failure with a preserved ejection fraction.
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Ischemic heart disease, mainly inferior and right ventricular myocardial infarction.
How Is TAPSE Measured?
This is best evaluated in the four-chamber view in echocardiography or cardiac magnetic resonance imaging (MRI). It measures the displacement of the tricuspid annulus concerning the right ventricular apex. In echocardiography, TAPSE is determined in M-mode by aligning the lateral tricuspid annulus with the ventricular apex. In MRI (magnetic resonance imaging), TAPSE can be evaluated in four-chamber cine images by calculating the difference between the lateral tricuspid annulus and the right ventricular apex.
Normal Values:
For echocardiography, the suggested cut-offs are
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TAPSE less than 17 mm (millimeter) shows the right ventricular systolic function.
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TAPSE less than 14 mm shows poor diagnosis in patients with chronic heart failure.
The tricuspid annular systolic excursion is not the commonly used measurement on cardiac MRI. Some suggest a cut-off value of 20 mm for echocardiography
What Is the Importance of TAPSE?
Right Ventricular Dysfunction:
To assess right ventricular dysfunction, TAPSE is a widely used feasible marker. It has also proven to be a feasible diagnostic marker for the assessment of cardiac diseases like heart failure. The apical four-chamber view with M-mode ultrasound is used for the measurement of the tricuspid ring in the longitudinal direction. Commonly used to evaluate the right ventricular systolic function. It is an in-depth study of the echocardiographic parameters.
This TAPSE procedure is simple and has less dependence on the quality of ultrasound images. It does not require any specific ultrasound equipment or software analysis. Another useful feature is repeatability. The decreased TAPSE values mean right ventricular systolic dysfunction.
Acute Pulmonary Embolism:
In acute pulmonary embolism, right ventricular failure increases the mortality rate. Diagnostic procedures like transesophageal echocardiography help to assess the right ventricular function, but due to the complexity of right ventricular anatomy, only certain echocardiography parameters are reliable. TAPSE is the validated parameter accepted globally for the functioning of the right ventricle. It describes the apex to-base shortening. TAPSE is easy to measure and highly specific. In patients with pulmonary embolism, the relation with the right ventricle is considered an important factor to predict the outcome.
In patients with pulmonary embolism, the TAPSE is used to evaluate the patients and to predict the prognosis. It is a predictive parameter for poor perioperative outcomes.
Right Ventricular Function and Cardiovascular Death:
Cardiovascular diseases are one of the leading causes of mortality and right ventricular function has a significant role in predicting the prognosis.
The prognostic value of right ventricular systolic function, by TAPSE is evaluated and can reduce the death from cardiovascular diseases in the population.
TAPSE helps in early identification of individuals at high risk of death from cardiovascular diseases.
The right ventricle is described as the forgotten chamber and the functioning of the right ventricle is an important predictor in cardiac and respiratory diseases. It provides a prognosis of various illnesses like
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Heart failure.
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Myocardial infarction.
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Chronic obstructive pulmonary disease.
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Primary pulmonary hypertension.
In patients with chronic obstructive pulmonary disease, the systolic dysfunction of the right ventricle is a marker of poor diagnosis. The prognosis of right ventricular systolic function is done by echocardiography. And it predicts cardiovascular death and other cardiovascular disease outcomes.
The risk for cardiovascular diseases increases with decreasing right ventricular function, as per the TAPSE assessment. Values below 24 mm are shown to have an increased risk of cardiovascular diseases, and values above 24 mm are not associated with the risk of cardiovascular diseases. The value of the TAPSE assessment is independent of age, sex, hypertension, smoking, diabetes mellitus, and decreasing right ventricular function. Thus the TAPSE is an independent predictor for cardiovascular diseases.
What Are the Benefits of TAPSE?
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It is a validated parameter for the assessment of global right ventricular function.
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It needs one view of the heart to get an apical four chambers.
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TAPSE can be done quickly.
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The apical four-chamber view can be used for the assessment of the left ventricle to right ventricle ratio.
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Assessment of left ventricular septal flattening sign (the sign of D).
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McConnell's sign where the right ventricular free wall akinesis sparing the apex.
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Higher interobserver reproducibility.
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It can be used in the evaluation of other clinical signs.
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The ultrasound view of TAPSE can be achieved in most patients, which is reliable and quick.
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Highly sensitive to right ventricular dysfunction.
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To find the right ventricular strain and risk.
Conclusion
Tricuspid annular plane systolic excursion is a procedure carried out to assess the right ventricular function. The right ventricle is less muscular than the left ventricle and difficult to cope with the rapid overload. The functioning of the right ventricle can be studied to assess the probable outcome of various cardiovascular and respiratory diseases. The procedure is easy and reliable and can be done in all patients.
