From the Guidelines
A TAPSE value of 1.4 cm indicates severe right ventricular (RV) systolic dysfunction, as it falls significantly below the normal range of ≥16 mm, suggesting impaired contractility of the right ventricle. This measurement is based on the most recent and highest quality study available, which defines reduced TAPSE as <16 mm 1. TAPSE is a simple echocardiographic parameter that measures the distance of systolic excursion of the lateral tricuspid valve annulus toward the apex in the four-chamber view. It serves as a reliable surrogate for overall RV systolic function because the longitudinal contraction is the predominant contributor to RV ejection.
Clinical Implications
A TAPSE of 1.4 cm should prompt further cardiac evaluation to determine the underlying cause, which could include conditions such as:
- Pulmonary hypertension
- Right-sided heart failure
- Pulmonary embolism
- Right ventricular infarction Management would depend on identifying and treating the underlying cause while monitoring for progression of RV dysfunction. Additional echocardiographic parameters and clinical correlation are recommended for a comprehensive assessment of right ventricular function, as TAPSE has some limitations as a single measure 1.
Recommendations
Given the severity of RV systolic dysfunction indicated by a TAPSE of 1.4 cm, it is crucial to prioritize further diagnostic workup and management strategies that address the underlying cause of RV dysfunction, with the goal of improving morbidity, mortality, and quality of life. This approach is supported by the most recent guidelines and studies on the evaluation and management of right-sided heart failure 1.
From the Research
TAPSE Measurement
- A Tricuspid Annular Plane Systolic Excursion (TAPSE) of 1.4 cm is significantly lower than the normal values reported in various studies 2, 3, 4, 5.
- According to a study published in the American Journal of Respiratory and Critical Care Medicine, a TAPSE of less than 1.8 cm was associated with greater right ventricular systolic dysfunction and poor survival estimates in patients with pulmonary arterial hypertension 2.
- Another study published in Echocardiography found that a TAPSE of less than 2.4 cm was a significant predictor of in-hospital mortality in critically ill patients 3.
- A TAPSE of 1.4 cm falls below the cutoff values reported in these studies, indicating potential right ventricular dysfunction and increased risk of adverse outcomes.
Clinical Implications
- Right ventricular dysfunction, as indicated by a low TAPSE, is an important predictor of mortality in various clinical conditions, including pulmonary hypertension, aortic stenosis, and critical illness 2, 3, 4.
- The measurement of TAPSE can provide valuable information on right ventricular function and help identify patients at high risk of adverse outcomes.
- Further evaluation and management of patients with a low TAPSE, such as 1.4 cm, may be necessary to address underlying conditions and improve outcomes 6, 2, 3, 4, 5.