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


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.


CONCLUSIONS
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.
Gupta
Saurabh
S
Division of Cardiology, Department of Medicine, University of Utah, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132-2401, USA.
Khan
Farman
F
Shapiro
Mia
M
Weeks
Sarah G
SG
Litwin
Sheldon E
SE
Michaels
Andrew D
AD
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000008:administration & dosage; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013318:Stroke Volume; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*
D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain