TAPSEANDRIGHT

VENTRICLE
SYSTOLICFUNCTION
Coordinator: Prof. Jolanta Justina Vakelyt
Made: Surugiu Iulian
2nd year resident cardiology (Moldova )

RIGHTVENTRICLE
Duetothecomplexanatomyof
theRV,assessmentofits
functioncanbeproblematic.
Therightventricleisacrescent
shapedthreedimensionalcavity
anditstransverseaxisiswrapped
aroundtheLV.

RVWALLMOTION

TheRVwallmotioniscomplex:

Isovolumiccontractionphase:Thesubepicardialfibres,
movestheventricleinacircumferentialdirection,rotationof
theventricle.

Duringtheejectionphase:longitudinalshorteningand
radialmotion.Mainlyislongitudinalshortening
controlledbythesubendocardialfibres.Secondaryradial
motionoftheRVfreewalltowardstheseptum.

Thereisawideanglebetweeninflowandoutflow,thisisway
longitudinalshorteningandperistalticmovementis
crucialtokeeptheintracavitarycirculationandtodirect
bloodintothepulmonaryarterialtree.

Radial shortening

Longitudinal shortening

RVEJECTIONFRACTION
MEASUREMENT
RVejectionfractionitsdifficultto

measurebecauseof:
dependentonloadingconditions,
ventricularinteraction,
myocardialstructure(trabeculation),
imagequality,
dependentonexamineropinionabout
endocardiumborder,
veryapproximately(wallmotion
abnormalities).

TAPSE
TAPSEasameasureofRVejection

fractionwasfirstproposedbyKauletal.
in1984,whodemonstratedaclose
correlationtoRVejectionfraction
determinedbyradionuclidetechnique.

Confirmedlatterusingthermodilution

techniques,MagneticResonanceImaging
andSimpsonsrightventricularEF.

TAPSE(2)

TAPSEiseasilymeasuredbyMmode,withthe
cursoralignedalongthedirectionofthetricuspid
lateralannulusintheapicalfourchamberview.

TAPSEisrelatedtoRVEF,becausetheRVfree
wallconsistspredominantlyoflongitudinaland
obliquemyocardialfibersand,isthemajor
contributortotheRVstrokevolume.

TAPSEhasaprognosticvalueconfirmedin
clinicaltrials.

ADVANTAGE
TAPSEissimpletomeasure,reproducible,

yetrobustmeasureofRVfunctioninpatients
withpulmonaryhypertension
Establishedprognosticvalue.
ValidatedagainstradionuclideEF.

LIMITATIONS
Representsonlythefreewallimplication.One
thirdofthepressuregeneratedintheRVismadeby
septumandcommonmusclefiberswithLV.
Inpatientswithdilatedcavityandvolume
overloadedRV,TAPSEcanerroneously
overestimaterightventricularfunction.

Angledependency.

Therearenobigclinicalstudy'sonTAPSE
cutoffandexactmeasures.

PROGNOSTICVALUE

Samadetal.assessedTAPSEinpatientsaftera
firstacutemyocardialinfarction,andshowedthat
TAPSE15mmwasassociatedwithincreased
mortality(45%at2years)comparedwithpatients
havingTAPSE>20mm(4%).

DecreasedRVejectionfractionestimatedby
TAPSEisindependentlyassociatedwith
mortalityduetoHF,evenafteradjustingforother
knownriskfactorsincludingLVejectionfractionor
thepresenceofvalvulardisease.

Negative correlation between pulmonary artery systolic pressure (PASP) and TAPSE (r=

0.67).

A Lpez-Candales et al. Postgrad Med J 2008;84:40-45

TAPSECORELATIONTOSHORTANDLONG
TERMMORTALITYINPATIENTSWITH
HEARTFAILURE

KaplanMeier(817patients)

PROGNOSTICVALUE(2)

RightventricularfunctionestimatedbyTAPSE,
isfoundtobeasignificantpredictorof
survival.

Whenadjustingforotherknownriskfactorsin
HFaswellasforthecoexistenceofCOPD,
TAPSEremainedanindependentpredictorof
survival,whereasleftventricularejection
fractionhadnoindependentprognostic
informationwhenTAPSEisincludedinthe
model.

RECOMMENDATIONSFORCARDIAC
CHAMBERQUANTIFICATIONJANUARY
2015

TricuspidannularlongitudinalexcursionbyM
mode(mm),measuredbetweenenddiastoleand
peaksystole,withproperalignmentofMmode
cursorwiththedirectionofRVlongitudinal
excursionshouldbeachievedfromtheapical4
chamberviewapproach.

TAPSE(mm):Mean243.5
Abnormalitythreshold<17mm

HOWTOMEASURE?

ISOVOLUMICCONTRACTION
TIME
Undernormalcircumstances,thelowend
diastolicpressureinthepulmonaryarteryis
quicklyexceededbythepressureriseinthe
RV,resultinginaveryshortorevenabsent
isovolumiccontractiontime.

TAPSE<17mmhiscutofflimitprognostic
valuewastakenfromstudy'swhereTAPSEwas
measuredfromenddiastoletopeaksystole.

Thereisnodataaboutcutofflimits

measuredforejectionperiod.

ATRIALCONTRIBUTION
TOTAPSE
Itwasestablishedthatrightatriacontribute
muchmoretoRVfillingthanleftatriatoLV
fillingindiastole.
UnderthiscircumstancesTAPSEvalueis
dependentonrightatriaproperfunction
andcontributiontoRVvolumeload.

Atthismomentitisnotknownwhatarethe
cutoffvalueofTAPSEinatrialdysfunction(ex:
atrialfibrillation),andprognosticpowerof
TAPSEinsuchsituation.

Itisimportantthatoneshould
notjudgeseverityofRV
functionimpairmentonthe
basisofoneparameter.
Instead,conclusionsshouldbe
drawnonacomplexand
multilateralevaluation
approach.