Tricuspid Annular Displacement Predicts Survival in Pulmonary Hypertension
Top Cited Papers
- 1 November 2006
- journal article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 174 (9), 1034-1041
- https://doi.org/10.1164/rccm.200604-547oc
Abstract
Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension. However, noninvasive assessment of the RV function is often limited by complex geometry and poor endocardial definition. To test whether the degree of tricuspid annular displacement (tricuspid annular plane systolic excursion [TAPSE]) is a useful echo-derived measure of RV function with prognostic significance in pulmonary hypertension. We prospectively studied 63 consecutive patients with pulmonary hypertension who were referred for a clinically indicated right heart catheterization. Patients underwent right heart catheterization immediately followed by transthoracic echocardiogram and TAPSE measurement. In the overall cohort, a TAPSE of less than 1.8 cm was associated with greater RV systolic dysfunction (cardiac index, 1.9 vs. 2.7 L/min/m2; RV % area change, 24 vs. 33%), right heart remodeling (right atrial area index, 17.0 vs. 12.1 cm(2)/m), and RV-left ventricular (LV) disproportion (RV/LV diastolic area, 1.7 vs. 1.2; all p < 0.001), versus a TAPSE of 1.8 cm or greater. In patients with pulmonary arterial hypertension (PAH; n = 47), survival estimates at 1 and 2 yr were 94 and 88%, respectively, in those with a TAPSE of 1.8 cm or greater versus 60 and 50%, respectively, in subjects with a TAPSE less than 1.8 cm. The unadjusted risk of death (hazard ratio) in patients with a TAPSE less than 1.8 versus 1.8 cm or greater was 5.7 (95% confidence interval, 1.3-24.9; p = 0.02) for the PAH cohort. For every 1-mm decrease in TAPSE, the unadjusted risk of death increased by 17% (hazard ratio, 1.17; 95% confidence interval, 1.05-1.30; p = 0.006), which persisted after adjusting for other echocardiographic and hemodynamic variables and baseline treatment status. TAPSE powerfully reflects RV function and prognosis in PAH.Keywords
This publication has 25 references indexed in Scilit:
- The right ventricle in pulmonary hypertensionCoronary Artery Disease, 2005
- Pulmonary Arterial HypertensionThe New England Journal of Medicine, 2004
- Prognosis of Pulmonary Arterial Hypertension*Social psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2004
- Prognostic impact of right ventricular involvement as assessed by tricuspid annular motion in patients with acute myocardial infarctionThe American Journal of Cardiology, 2002
- Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathyThe American Journal of Cardiology, 2000
- Prognostic significance of echocardiographically estimated right ventricular shortening in advanced heart failureThe American Journal of Cardiology, 1998
- Survival in Patients with Primary Pulmonary HypertensionAnnals of Internal Medicine, 1991
- Assessment of right ventricular function using two-dimensional echocardiographyAmerican Heart Journal, 1984
- Regression Models and Life‐TablesJournal of the Royal Statistical Society: Series B (Methodological), 1972
- The Functional Anatomy of Ventricular ContractionCirculation Research, 1953