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Tricuspid annular plane systolic excursion (TAPSE) in pediatric pulmonary hypertension: Integrating right ventricular
Martin Koestenberger1, Alexander Avian2, Massimiliano Cantinotti3
1Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria.
Insights
New echocardiographic ratios improve assessment of right ventricular function in pediatric pulmonary hypertension. These multiparametric indices, unlike single measures, better distinguish functional classes in children with PH.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Pulmonary Hypertension
Background:
- Tricuspid annular plane systolic excursion (TAPSE) is a key echocardiographic measure of right ventricular (RV) systolic function in pediatric pulmonary hypertension (PH).
- Current research emphasizes multi-parametric approaches for RV function assessment in children with PH.
Purpose of the Study:
- To investigate the utility of RV ejection efficiency (RVEe; TAPSE/indexed pulmonary vascular resistance) and the TAPSE/pulmonary systolic arterial pressure (PASP) ratio.
- To assess the association of these novel indices with NYHA functional class (FC) and modified ROSS score in pediatric PH.
Main Methods:
- Retrospective analysis of 42 children diagnosed with PH.
- Calculation of RVEe (TAPSE/PVRi) and TAPSE/PASP ratio.
- Correlation of these indices with NYHA FC and modified ROSS score.
Main Results:
- Both RVEe and the TAPSE/PASP ratio showed an inverse relationship with NYHA FC and modified ROSS score.
- Multiparametric variables (RVEe, TAPSE/PASP) demonstrated more pronounced differences between functional classes compared to TAPSE alone.
- These ratios effectively distinguish between different NYHA FC/modified ROSS score groups.
Conclusions:
- Multiparametric echocardiographic indices like RVEe and TAPSE/PASP ratio offer improved assessment of RV function in pediatric PH.
- These ratios are more effective than TAPSE alone in differentiating functional severity in children with PH.
- A multiparametric approach enhances the clinical utility of echocardiography for evaluating pediatric pulmonary hypertension.
Abstract:
The tricuspid annular plane systolic excursion (TAPSE) has evolved into one of the major echocardiographic indicators of systolic right ventricular (RV) longitudinal function in pediatric pulmonary hypertension (PH). Current RV function research in children with PH focusses on multi-parametric approaches that include TAPSE. The RV ejection efficiency (RVEe) is one of the new variables that reflects the relationship of TAPSE divided by the indexed pulmonary vascular resistance (PVRi) measured by cardiac catheterization. Here, we investigated not only RVEe, but also the ratio of TAPSE divided by pulmonary systolic arterial pressure (PASP; TAPSE/PASP ratio), and a possible association of these indices with NYHA functional class (FC) or the modified ROSS score in 42 children with PH. Both, the RVEe (TAPSE/PVRi) and the TAPSE/PASP ratio were inversely related to NYHA FC and the modified ROSS score in the pediatric PH compared. Compared to TAPSE as single measure, in both multiparametric variables (RVEe, TAPSE/PASP) more pronounced differences in subjects with different NYHA FC/modified ROSS score values were observed. Taken together, the RVEe (TAPSE/PVRi) and TAPSE/PASP ratio distinguish between NYHA FC/modified ROSS score compared to the single echocardiographic variable TAPSE, highlighting the usefulness of a multiparametric approach.
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