Tricuspid annular plane systolic excursion

Tricuspid annular plane systolic excursion (TAPSE) also known as tricuspid annular motion refers to the displacement of the tricuspid valvular plane in the z-direction, reflects right ventricular longitudinal contraction or shortening.

Usage

Tricuspid annular plane systolic excursion can be measured for the evaluation of right ventricular longitudinal function which can be affected in various clinical conditions.

Traditionally tricuspid annular plane systolic excursion is assessed with echocardiography but it can be also measured with cardiac magnetic resonance cine imaging ^1-8:

Tricuspid annular plane systolic excursion can be used for the assessment of prognosis in the following clinical settings ^1-4:

• pulmonary arterial hypertension
• congestive heart failure
• right ventricular dysfunction in heart failure with a preserved ejection fraction
• ischaemic heart disease in particular inferior and right ventricular myocardial infarction
• non-ischaemic cardiomyopathy
• congenital heart defects (e.g. tetralogy of Fallot)

Measurement

Tricuspid annular plane systolic excursion is best evaluated in the 4-chamber view in M-mode echocardiography or cardiac MRI by measuring the displacement of the tricuspid annulus in relation to the right ventricular apex.

Echocardiography

Tricuspid annular plane systolic excursion can be determined in M-mode echocardiography by aligning the lateral tricuspid annulus with the ventricular apex in the apical four-chamber view and measuring the lateral annular displacement ³.

MRI

Tricuspid annular plane systolic excursion can be assessed in four-chamber cine-images by calculating the difference of the distance between the lateral tricuspid annulus and the right ventricular apex at end-systole versus end-diastole ⁵.

Interpretation

Tricuspid annular plane systolic excursion reflects right ventricular longitudinal function.  

Validation

Tricuspid annular plane systolic excursion is validated against radionuclide ejection fraction, fast and easily obtainable, reproducible and has established prognostic value ^1-4.

Limitations include the following ^1-4:

• inaccuracy in case of regional right ventricular wall-motion abnormalities
• inaccuracy in case of cardiac translation
• inaccuracy and poor correlation with right ventricular ejection fraction after cardiac surgery
• only partially representative of right global systolic function (RVOT contribution is omitted)
• angle dependency (echocardiography)

Normal values

Cut-off values suggested for echocardiography ^1-4:

• TAPSE <17 mm indicates right ventricular systolic dysfunction
• TAPSE <14 mm indicates a poor prognosis in patients with chronic heart failure

Tricuspid annular plane systolic excursion is not widely used as a measurement on cardiac MRI, some suggest a cut-off value of 20 mm ⁵ some use the same value suggested for echocardiography ⁶.

See also

• cardiac function
• right ventricular function (point of care ultrasound)