Modified Tricuspid Annular Plane Systolic Excursion Using Transesophageal Echocardiography and Its Utility to Predict...

Perioperative right ventricular (RV) function is important for determining the postoperative course in heart transplantation (HT) and left ventricular assist device (LVAD) implantation. The authors describe a modified tricuspid annular plane systolic excursion (m-TAPSE) using transesophageal echocardiography and assessed its clinical utility in HT and LVAD.

Retrospective medical record review.

A single tertiary-care medical center.

Forty-eight patients who underwent successful HT and 80 patients who underwent successful LVAD placement.

Statistically significant correlation between m-TAPSE and RV fractional area change (FAC) was seen for HT and LVAD (r = 0.462, p < 0.01 and r = 0.597, p < 0.01, respectively). For HT, receiver operating characteristics curve analysis yielded that m-TAPSE <0.64 cm provides 100% specificity and 57.1% sensitivity in predicting postoperative nitric oxide (NO) use, whereas RV FAC <24.1% provides 95.1% specificity and 71.4% sensitivity in predicting postoperative NO use (area under the curve 0.798 [95% confidence interval (CI), 0.595-1] v 0.826 [95% CI, 0.581-1], p = 0.397). For LVAD, m-TAPSE <0.71 cm provides 66.7% specificity and 87.5% sensitivity in predicting postoperative NO use, whereas RV FAC <16.3% provides 79.4% specificity and 62.5% sensitivity in predicting postoperative NO use (area under the curve 0.829 [95% CI, 0.732-0.927] v 0.691 [95% CI, 0.54-0.842], p < 0.05).

m-TAPSE validated a good correlation to RV systolic function as reflected by RV FAC for both HT and LVAD. For HT, m-TAPSE was helpful for predicting postoperative NO use; whereas for LVAD, m-TAPSE was helpful for predicting postoperative NO use and RV assist device implantation. m-TAPSE should be considered as a useful parameter to decide postoperative management for these cases.