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European Journal of Echocardiography Advance Access originally published online on April 19, 2008
European Journal of Echocardiography 2008 9(6):766-771; doi:10.1093/ejechocard/jen147
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

The associations between tricuspid annular plane systolic excursion (TAPSE), ventricular dyssynchrony, and ventricular interaction in heart failure patients

Saurabh Gupta1, Farman Khan1, Mia Shapiro2, Sarah G. Weeks3, Sheldon E. Litwin1 and Andrew D. Michaels1,*

1 Division of Cardiology, Department of Medicine, University of Utah, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132-2401, USA
2 Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
3 Division of Cardiology, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada

Received 21 December 2007; accepted after revision 21 March 2008; online publish-ahead-of-print 19 April 2008.

* Corresponding author. Tel: +1 801 585 5971; fax: +1 801 581 7735. E-mail address: andrew.michaels{at}hsc.utah.edu


  Abstract

Aims: Ventricular interactions may be mediated by loading conditions and biventricular timing and coordination. We sought to understand the relationships between right (RV) and left ventricular (LV) function and dyssynchrony, examine the RV correlates of LV dyssynchrony, and determine whether improved loading conditions affect inter-ventricular interaction.

Methods and results: In 25 heart failure patients [15 with left ventricular ejection fraction (LVEF) < 40%; 10 with LVEF ≥ 50%], Doppler echocardiography and invasive bi-ventricular pressure–volume haemodynamics were obtained at baseline and 30 min after infusion of the recombinant B-type natriuretic peptide vasodilator nesiritide. RV and LV intra-ventricular dyssynchrony was measured invasively using a pressure–conductance catheter. Patients with reduced LVEF had greater LV dyssynchrony (31 ± 3 vs. 24 ± 7%; P = 0.003) compared to those with preserved LVEF. Tricuspid annular plane systolic excursion (TAPSE) had the highest correlation with LV dyssynchrony (r = –0.52; P = 0.0002) compared to other RV echocardiographic parameters. The association between TAPSE and LV dyssynchrony was independent of RVEF and LVEF (P = 0.008). There were no acute changes in the correlations between LV dyssynchrony and TAPSE after nesiritide.

Conclusion: TAPSE and LV dyssynchrony are strongly associated, independent of RV and LV ejection fraction. Of the RV echocardiographic parameters, TAPSE has the highest predictive value of LV dyssynchrony, and remained significant after vasodilator unloading.

Keywords: Heart failure; Dyssynchrony; Brain natriuretic peptide; hemodynamics


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