Tricuspid annular plane systolic excursion in the assessment of right ventricular function in children and adolescents after repair of tetralogy of Fallot

Abstract

Background: Assessing right ventricular (RV) performance is essential for patients with tetralogy of Fallot (TOF). The aim of this study was to investigate the reliability and validity of tricuspid annular plane systolic excursion (TAPSE) against cardiac magnetic resonance imaging measures and cardiopulmonary exercise testing.

Methods: A retrospective study was performed in 125 outpatients with repaired TOF with available protocol-driven echocardiography, cardiac magnetic resonance imaging, and exercise stress testing obtained as part of a cross-sectional study. TAPSE was measured on the two-dimensional apical four-chamber view on echocardiography by two readers. Multivariate linear regression was used to examine the association between TAPSE and measures of RV function and exercise capacity.

Results: The mean age was 12.6 ± 3.3 years, 41 patients (33%) were female, and 104 (83%) were white. TAPSE averaged 1.6 ± 0.37 cm, with an interreader intraclass correlation coefficient of 0.78 (n = 18). TAPSE was significantly associated with cardiac magnetic resonance-based RV stroke volume after adjustment for gender and body surface area (β = 13.8; 95% confidence interval, 2.25-25.30; P = .02). TAPSE was not associated with cardiac magnetic resonance-based RV ejection fraction (P = .77). On exercise testing, TAPSE was not associated with peak oxygen consumption, percentage of predicted oxygen consumption, oxygen pulse, or the ventilatory equivalent for carbon dioxide in patients with maximal exercise stress testing (n = 73 [58%]).

Conclusions: TAPSE is reproducibly measured by echocardiography in patients with TOF. It is not associated with RV ejection fraction or exercise performance, and its association with RV stroke volume may be confounded by body size. On the basis of these results, TAPSE is not representative of global RV performance in patients with TOF.

Keywords: 2D; BSA; Body surface area; CI; CMR; Carbon dioxide production; Cardiac magnetic resonance; Confidence interval; EST; Echocardiography; Exercise; Exercise stress testing; ICC; Intraclass correlation coefficient; Magnetic resonance imaging; Oxygen consumption; Predicted percentage of maximum oxygen consumption; RV; RVEDV; RVEF; RVESV; Right ventricular; Right ventricular ejection fraction; Right ventricular end-diastolic volume; Right ventricular end-systolic volume; TAPSE; TOF; Tetralogy of Fallot; Tricuspid annular plane systolic excursion; Two-dimensional; VE/Vco(2); Vco(2); Ventilatory equivalent of carbon dioxide; Vo(2); Vo(2)max%.

Figure 1

Example of TAPSE measurement by 2D echocardiography on apical four-chamber view from a study patient. (Top) Tricuspid valve annulus at end-diastole (distance to a point on the screen, 4.41 cm). (Bottom) Tricuspid valve annulus in end-systole (distance to the same point on the screen, 3.12 cm). TAPSE = 1.29 cm.

Figure 2

Age distribution of the study cohort. The graph displays the number of patients per year of age.

Figure 3

Scatterplot with linear regression line demonstrating the relationship of TAPSE and RVEF.

Figure 4

Receiver operating characteristic (ROC) curve displaying the ability of TAPSE to identify decreased RVEF (<50%) on CMR. C-statistic = 0.57 (95% CI, 0.39–0.75).