The use of tricuspid annular plane systolic excursion in assessment of right ventricular contractility in children

Echocardiographic assessment of the contractility of the right ventricle (RV) is a difficult task due to its special shape. Two indicators are most often used to assess pancreatic contractility: the amplitude of the systolic displacement of the plane of the fibrous ring of the tricuspid valve and right ventricular fractional area change (FAC) due to good reproducibility and ease of measurement. The correctness of using TAPSE has been increasingly questioned lately.

Aim: To study the association of tricuspid annular plane systolic excursion (TAPSE) with pancreatic contractility, changes in the volume of the right chambers in children with atrial septal defect (ASD) during surgical treatment. To evaluate the relationship of TAPSE with the indicators of anthropometry.

Material and Methods. The examination was performed on the basis of a retrospective analysis of two-dimensional echocardiographic data. Three-dimensional echocardiography (3D echo) was the reference method for assessing RV contractility.

Results. Based on a retrospective correlation analysis of echocardiography data in 729 healthy children aged 1–17 years and 120 children with ASD of the same age, it was found that the maximum relationship between TAPSE was observed with age (r = 0.54) and anthropometric data (r = 0.59). There was a fairly high correlation between the linear dimensions of the right atrium and the right ventricle (r = 0.59). The correlation of TAPSE and RV ejection fraction (EF) according to 3D echo data was absent in the control group and in children with ASD. The indicator was evaluated in the near future (6 days) and in the long term (1–3 years) after surgical correction in 60 children with ASD and 30 with coarctation of the aorta. At all stages after surgery, the indicator decreased in all operated patients, did not recover after 1 year and had no correlation with the pancreatic ejection fraction according to 3D echo data.

Conclusions. In children without structural pathology of the heart, the TAPSE indicator does not reflect the contractility of the right ventricle and depends on anthropometric data and the linear dimensions of the right chambers. TAPSE in ASD children was more depended by volumetric overload of the right chambers than by contractility of the right ventricle. Contractility of the right ventricle in children after cardiac surgery cannot be correctly assessed using TAPSE.

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