Evaluation of tricuspid annular plane systolic excursion measured with cardiac MRI in children with tetralogy of Fallot

Abstract

Background Aneurysmal dilation of the right ventricular outflow tract complicates assessment of right ventricular function in patients with repaired tetralogy of Fallot. Tricuspid annular plane systolic excursion is commonly used to estimate ejection fraction. We hypothesized that tricuspid annular plane systolic excursion measured by cardiac magnetic resonance imaging approximates global and segmental right ventricular function, specifically right ventricular sinus ejection fraction, in pediatric patients with repaired tetralogy of Fallot. Methods Tricuspid annular plane systolic excursion was measured retrospectively on cardiac magnetic resonance images in 54 patients with repaired tetralogy of Fallot. Values were compared with right ventricular global, sinus, and infundibular ejection fractions. Tricuspid annular plane systolic excursion was: 1) indexed to body surface area, 2) converted into a fractional value, and 3) converted into published pediatric Z-scores. Results Tricuspid annular plane systolic excursion measurements had good agreement between observers. Right ventricular ejection fraction did not correlate with the absolute or indexed tricuspid annular plane systolic excursion and correlated weakly with fractional tricuspid annular plane systolic excursion (r=0.41 and p=0.002). Segmental right ventricular function did not appreciably improve correlation with any of the tricuspid annular plane systolic excursion measures. Pediatric Z-scores were unable to differentiate patients with normal and abnormal right ventricular function. Conclusions Tricuspid annular plane systolic excursion measured on cardiac magnetic resonance imaging correlates poorly with global and segmental right ventricular ejection fraction in pediatric patients with repaired tetralogy of Fallot. Tricuspid annular plane systolic excursion is an unreliable approximation of right ventricular function in this patient population.

Tricuspid annular plane systolic excursion as a marker of right ventricular dysfunction in pediatric patients with dilated cardiomyopathy

“…TAPSE quantifies the predominant longitudinal movement of the RV to assess function based on the motion of the tricuspid annulus. In previous studies, TAPSE has been used to measure RV function in adults patients with DCM and pediatric patients with other forms of congenital heart disease . Our study suggests that 2D TAPSE can be reliably measured in the majority of pediatric patients with DCM and if considered prospectively can be assessed either with 2D TAPSE or M‐mode TAPSE.…”

“…In previous studies, TAPSE has been used to measure RV function in adults patients with DCM and pediatric patients with other forms of congenital heart disease. 6,21,22 Our study suggests that 2D TAPSE can and found that TAPSE added significant prognostic information to specific patients with LV dysfunction and should be routinely measured in patients with DCM. 6 Similarly, in our study, the odds of primary outcome were significantly elevated in those with TAPSE score of ≤−4 and LVEF ≤30%.…”

Echocardiographic evaluation of the right heart

“…Many conditions have been described where TAPSE and S’ do not reflect true RVF. These include patients after cardiac surgery, tetralogy of Fallot, and tricuspid regurgitation [ 12 , 15 , 27 , 29 ]. In particular, in these cases new methods such as global longitudinal strain and 3D measurements of RV volumes and RVEF deserve attention for future studies.…”