Yuan Tan1, Aristomenis Manouras2,3, Lars H Lund2,3, Ashwin Venkateshvaran2,3. 1. Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden. 2. Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: Tricuspid annular plane systolic excursion (TAPSE) is a recommended quantitative measure of right ventricular (RV) longitudinal function assessed by M-mode echocardiography. Offline alternatives are desirable when TAPSE is unavailable. This study aimed to assess the feasibility, reliability, and agreement between retrospectively obtained measures of tricuspid annular displacement using Doppler tissue imaging (TADDTI ) and speckle tracking echocardiography (TADSTE ) compared with reference TAPSE. METHODS: Consecutive subjects referred for evaluation of heart failure were enrolled. Subjects in atrial fibrillation, significant valvular disease, or with poor image quality were excluded. TAPSE was measured during the examination using M-mode. TADSTE was measured as the maximal longitudinal displacement of the RV basal segment in systole using speckle strain imaging. TADDTI was derived offline from color-DTI superimposed grayscale images. RESULTS: 107 subjects (age 60 ± 16; 48% female) were analyzed. Both TADDTI and TADSTE demonstrated good feasibility and excellent intra- and inter-observer concordances. Although both measures demonstrated strong association with TAPSE, TADDTI showcased lower specificity to identify RV dysfunction and higher false positives. Bland-Altman analysis revealed a tendency of TADDTI to underestimate TAPSE (bias = 1.40; SD = 2.74 mm) as compared with TADSTE (bias = 0.27; SD = 2.30mm). Wide limits of agreement were observed for both methods. CONCLUSIONS: TADSTE and TADDTI provide reproducible and feasible quantification of RV function. However, TADDTI significantly underestimates TAPSE limiting the interchangeability of these modalities.
BACKGROUND: Tricuspid annular plane systolic excursion (TAPSE) is a recommended quantitative measure of right ventricular (RV) longitudinal function assessed by M-mode echocardiography. Offline alternatives are desirable when TAPSE is unavailable. This study aimed to assess the feasibility, reliability, and agreement between retrospectively obtained measures of tricuspid annular displacement using Doppler tissue imaging (TADDTI ) and speckle tracking echocardiography (TADSTE ) compared with reference TAPSE. METHODS: Consecutive subjects referred for evaluation of heart failure were enrolled. Subjects in atrial fibrillation, significant valvular disease, or with poor image quality were excluded. TAPSE was measured during the examination using M-mode. TADSTE was measured as the maximal longitudinal displacement of the RV basal segment in systole using speckle strain imaging. TADDTI was derived offline from color-DTI superimposed grayscale images. RESULTS: 107 subjects (age 60 ± 16; 48% female) were analyzed. Both TADDTI and TADSTE demonstrated good feasibility and excellent intra- and inter-observer concordances. Although both measures demonstrated strong association with TAPSE, TADDTI showcased lower specificity to identify RV dysfunction and higher false positives. Bland-Altman analysis revealed a tendency of TADDTI to underestimate TAPSE (bias = 1.40; SD = 2.74 mm) as compared with TADSTE (bias = 0.27; SD = 2.30mm). Wide limits of agreement were observed for both methods. CONCLUSIONS: TADSTE and TADDTI provide reproducible and feasible quantification of RV function. However, TADDTI significantly underestimates TAPSE limiting the interchangeability of these modalities.
Authors: Patrick Hetz; Markus Pirklbauer; Silvana Müller; Lydia Posch; Maria Gummerer; Martin Tiefenthaler Journal: Am J Nephrol Date: 2020-07-13 Impact factor: 3.754