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Prevalence of, Associations With, and Prognostic Value of Tricuspid Annular Plane Systolic Excursion (TAPSE) Among Outatients Referred for the Evaluation of Heart Failure

  • Thibaud Damy, MD, PhD

      Affiliations

    • Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom
    • Fédération de Cardiologie at the Assistance Publique des Hôpitaux de Paris, Groupe Henri-Mondor Albert-Chenevier, Créteil, France
    • Unité U955, Institut National de la Santé Et de la Recherche Médicale, Créteil, France
    • Faculté de Médecine, Université Paris 12, Créteil, France
    • Corresponding Author InformationReprint requests: Dr Thibaud Damy, Department of Cardiology, Hull York Medical School, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, East Riding, Yorkshire, UK. Tel: 0044 (0) 1 482 461 917; Fax: 0044 (0) 1 482 461 779.
    • ,
  • Anna Kallvikbacka-Bennett

      Affiliations

    • Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom
    • ,
  • Kevin Goode, PhD

      Affiliations

    • Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom
    • ,
  • Olga Khaleva, MD

      Affiliations

    • Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom
    • ,
  • Christian Lewinter, MD

      Affiliations

    • Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom
    • ,
  • James Hobkirk

      Affiliations

    • Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom
    • ,
  • Nikolay P. Nikitin, MD

      Affiliations

    • Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom
    • ,
  • Jean-Luc Dubois-Randé, MD, PhD

      Affiliations

    • Fédération de Cardiologie at the Assistance Publique des Hôpitaux de Paris, Groupe Henri-Mondor Albert-Chenevier, Créteil, France
    • Unité U955, Institut National de la Santé Et de la Recherche Médicale, Créteil, France
    • Faculté de Médecine, Université Paris 12, Créteil, France
    • ,
  • Luc Hittinger, MD, PhD

      Affiliations

    • Fédération de Cardiologie at the Assistance Publique des Hôpitaux de Paris, Groupe Henri-Mondor Albert-Chenevier, Créteil, France
    • Unité U955, Institut National de la Santé Et de la Recherche Médicale, Créteil, France
    • Faculté de Médecine, Université Paris 12, Créteil, France
    • ,
  • Andrew L. Clark, MA, MD, FRCP

      Affiliations

    • Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom
    • ,
  • John G.F. Cleland, MD, FACC

      Affiliations

    • Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom

Received 27 May 2011; received in revised form 12 October 2011; accepted 14 December 2011. published online 27 January 2012.
Corrected Proof

Abstract 

Background

Prevalence, predictors, and prognostic value of right ventricular (RV) function measured by the tricuspid annular plane systolic excursion (TAPSE) in patients with chronic heart failure (CHF) symptoms with a broad range of left ventricular ejection fraction (LVEF) are unknown.

Methods and Results

Of 1,547 patients, mean (±SD) age was 71 ± 11 years, 48% were women, median (interquartile range [IQR]) TAPSE was 18.5 (14.0–22.7) mm, mean LVEF was 47 ± 16%, 47% had LVEF ≤45% and 67% were diagnosed with CHF, defined as systolic (S-HF) if LVEF was ≤45% and as heart failure with preserved ejection fraction (HFPEF) if LVEF was >45% and treated with a loop diuretic. During a median (IQR) follow-up of 63 (41–75) months, mortality was 34%. In multivariable analysis, increasing age, N-terminal pro–B-type natriuretic peptide (NT-proBNP), New York Heart Association functional class, right atrial volume index, and transtricuspid pressure gradient; lower TAPSE, diastolic blood pressure, and hemoglobin; and atrial fibrillation (AF) or COPD were associated with an adverse prognosis. Receiver operating characteristic curve analysis identified a TAPSE of 15.9 mm as the best prognostic threshold (P = .0001); 47% of S-HF and 20% of HFPEF had a TAPSE of <15.9 mm. The main associations with a TAPSE <15.9 mm were higher NT-proBNP, presence of atrial fibrillation and presence of LV systolic dysfunction.

Conclusions

In patients with CHF, low values for TAPSE are common, especially in those with reduced LVEF. TAPSE, unlike LVEF, was an independent predictor of outcome.

Key Words: Heart failure, prognosis, right ventricle, echocardiography, TAPSE

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 Funding: Dr Damy received a grant from the Société Francaise de Cardiologie/Federation Francaise de Cardiologie.

 See page 10 for disclosure information.

PII: S1071-9164(11)01321-2

doi:10.1016/j.cardfail.2011.12.003

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