Tricuspid Annular Plane Systolic Excursion Is Reduced in Infants with Pulmonary Hypertension

BackgroundRight ventricular (RV) function is reduced in infants with pulmonary hypertension (PH) but echocardiographic assessment can be challenging. We sought to determine the role of tricuspid annular plane systolic excursion (TAPSE) in infants with PH and compared it with other markers such as tricuspid annular S' and RV fractional area change (RVFAC). MethodsRetrospective review of medical records of 30 infants treated for PH and 69 healthy controls from January 2012 to November 2012 was performed. Patients with significant congenital heart disease were excluded. Offline analysis of echocardiograms was performed to obtain TAPSE, tricuspid annular S', and RVFAC. TAPSE was indexed to body surface area (TAPSE/BSA). Logistic regression analysis was performed to evaluate the relation between echocardiographic markers and PH. ResultsTAPSE and TAPSE/BSA were significantly lower in PH patients. PH patients were younger than controls; however, TAPSE was significantly lower in PH patients after matching with controls by age. Tricuspid annular S' was decreased in PH patients, but RVFAC was similar. On multivariate analysis, tricuspid S' did not have a significant effect on the probability of PH (P=0.067). The odds of PH significantly increased with each 1mm decrease in TAPSE (OR 1.78, 95% CI 1.26-2.45). Inter-observer agreement for TAPSE showed concordance correlation coefficient of 0.89. ConclusionsTAPSE is a feasible and reproducible marker of RV systolic function in infants with PH and is superior to tricuspid annular S' and RVFAC. Longitudinal studies are needed to evaluate the role of TAPSE in serial evaluation of PH.