Validation of Tricuspid Annular Displacement by Tissue Doppler in Pulmonary Hypertension

Tricuspid annular plane systolic excursion (TAPSE) is primarily measured using motion-mode (M-mode) echocardiography. However, image resolution doesn't always provide clear visualization. In these cases, tissue Doppler imaging (TDI) may offer a valuable alternative for right ventricular assessment. To validate TDI-derived TAPSE (TAPSE-TDI) against M-mode TAPSE and compare their diagnostic utility for right heart catheterization-confirmed pulmonary hypertension(PH). We analyzed 304 healthy volunteers and 310 PH patients in a case-control study. M-mode TAPSE and TAPSE-TDI were measured in the RV-focused apical four-chamber view. TAPSE-TDI was calculated by averaging the systolic and diastolic signals from the lateral tricuspid annulus. Agreement between methods was quantified using bias, percentile precision, and intra-class coefficient (ICC). The dependence of annular motion on body size, sex, and heart rate was evaluated with weighted regression. We assessed PH discrimination using receiver operating curve (ROC) analysis, comparing TAPSE, TAPSE-TDI, and RV TDI peak systolic velocity (s'). Thresholds were further tested using Classification and Regression Tree (CART) analysis. TAPSE-TDI demonstrated a strong linear relationship with TAPSE (r = 0.945, p < 0.001) and a slope of 1.02 in no-intercept regression. TAPSE-TDI demonstrated excellent reproducibility (ICC = 0.937), and its reference range fell within the guideline-recommended values. For PH diagnosis, TAPSE and TAPSE-TDI showed good discrimination (AUC > 0.83), with the TAPSE/RVSP ratio outperforming (both AUC > 0.96). CART analysis identified optimal thresholds of 16.68 mm for TAPSE and 15.88 mm for TAPSE-TDI to discriminate PH. TAPSE measured using TDI was closely related to M-mode and both better discriminated PH than RV s'.