Modified Tricuspid Annular Plane Systolic Excursion and Its Association with Postoperative Course
Lencho T, Morita Y. Modified Tricuspid Annular Plane Systolic Excursion and Its Association with Postoperative Course. 2017; 124(5S):111-112.
Introduction: Perioperative right ventricular (RV) function is one of the critical factors for determining postoperative course in heart transplantation (HT). Tricuspid annular plane systolic excursion (TAPSE) has become one of the popular ways for assessing RV systolic function and is recommended in American Society of Echocardiography (ASE) Guideline, but TAPSE is not utilized regularly Intra-operatively because its measurement has been described by using M-mode transthoracic echocardiography (TTE). The authors describe a modified TAPSE (m-TAPSE) using the transesophageal echocardiography (TEE) mid-esophageal 4-chamberview (ME4CV) and assessed its association with and predictive value for postoperative course in HT.
Methods: After our Institutional Review Board approval, we did retrospective chart review of 61 HT cases from 2014 to 2016. Patients with intraoperative nitric oxide (NO), extracorporeal membrane oxygenation (ECMO), and suboptimal TEE image were excluded and 43 patients' medical records were reviewed. TEE ME 4CV after chest closure was used for investigation. Spearman's coefficient correlation (due to nonlinearity) were calculated to assess the relationship between m-TAPSE and post-operative course indices (Time to extubate, ICU length of stay, and Hospital length of stay). Also, receiver operating characteristic (ROC) curve analysis was performed for assessing the effectiveness of m-TAPSE and RV fractional area change (FAC) to predict postoperative course.
Results: Coefficient correlation for m-TAPSE with time to extubate (TIME ex), ICU length of stay (LOS), and Hospital LOS were -0.192 (p=0.217), -0.376 (p=0.0131), and -0.21 (p=0.177), respectively. Coefficient correlation for RV FAC with TIMEex, ICU LOS, and Hospital LOS were -0.119 (p=0.496), -0.334 (p=0.0285), and -0.112 (p=0.475), respectively. Based on area under the ROC curve analysis, m-TAPSE>1.58cm and RV FAC>37.5% were the best cutoff for predicting prolonged ICU stay (>7days). Using these cutoff, m-TAPSE was better correlated with prolonged ICU LOS than RV FAC (area under the ROC curve was 0.719 and 0.617, respectively). Also, on univariate analysis, odds ratio (OR) of small m-TAPSE(7days) was 5,4 (p=0.0133), and OR of small RV FAC(7days) was 2.53 (p=0.15).
Conclusion: These results suggest that m-TAPSE and RV FAC correlate well with ICU LOS, and m-TAPSE is better than RV FAC in terms of predicting prolonged ICU stay (>7days). The cutoff we calculated for prolonged ICU LOS is 1.58cm for m-TAPSE and 37.5% for RV FAC, both of which are close to the cutoff shown in ASE Guideline (1.6cm for TAPSE and 35% for RV FAC). M-TAPSE is easy and quick to calculate needing only TEE ME 4CV, and is ideal for busy situations in HT surgery. Considering that RV FAC is recommended for quantitatively estimating RV function in ASE guideline and that RV function is proved to be one of the determining factors for ICU LOS, m-TAPSE should also be considered as an easily measurable parameter to evaluate ICU LOS.
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