title: Prevalence of, associations with, and prognostic value of tricuspid annular plane systolic excursion (TAPSE) among out-patients referred for the evaluation of heart failure.
abstract: BACKGROUND
  Prevalence, predictors, and prognostic value of right ventricular (RV) function measured by the tricuspid annular plane systolic excursion (TAPSE) in patients with chronic heart failure (CHF) symptoms with a broad range of left ventricular ejection fraction (LVEF) are unknown.
  
  
  RESULTS
  Of 1,547 patients, mean (±SD) age was 71 ± 11 years, 48% were women, median (interquartile range [IQR]) TAPSE was 18.5 (14.0-22.7) mm, mean LVEF was 47 ± 16%, 47% had LVEF ≤45% and 67% were diagnosed with CHF, defined as systolic (S-HF) if LVEF was ≤45% and as heart failure with preserved ejection fraction (HFPEF) if LVEF was >45% and treated with a loop diuretic. During a median (IQR) follow-up of 63 (41-75) months, mortality was 34%. In multivariable analysis, increasing age, N-terminal pro-B-type natriuretic peptide (NT-proBNP), New York Heart Association functional class, right atrial volume index, and transtricuspid pressure gradient; lower TAPSE, diastolic blood pressure, and hemoglobin; and atrial fibrillation (AF) or COPD were associated with an adverse prognosis. Receiver operating characteristic curve analysis identified a TAPSE of 15.9 mm as the best prognostic threshold (P = .0001); 47% of S-HF and 20% of HFPEF had a TAPSE of <15.9 mm. The main associations with a TAPSE <15.9 mm were higher NT-proBNP, presence of atrial fibrillation and presence of LV systolic dysfunction.
  
  
  CONCLUSIONS
  In patients with CHF, low values for TAPSE are common, especially in those with reduced LVEF. TAPSE, unlike LVEF, was an independent predictor of outcome.
authors.affiliation: Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, United Kingdom. thibaud.damy@hmn.aphp.fr
authors.forename: Thibaud
authors.initials: T
authors.lastname: Damy
authors.forename: Anna
authors.initials: A
authors.lastname: Kallvikbacka-Bennett
authors.forename: Kevin
authors.initials: K
authors.lastname: Goode
authors.forename: Olga
authors.initials: O
authors.lastname: Khaleva
authors.forename: Christian
authors.initials: C
authors.lastname: Lewinter
authors.forename: James
authors.initials: J
authors.lastname: Hobkirk
authors.forename: Nikolay P
authors.initials: NP
authors.lastname: Nikitin
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois-Randé
authors.forename: Luc
authors.initials: L
authors.lastname: Hittinger
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D013318:Stroke Volume; D015996:Survival Rate; D014261:Tricuspid Valve; D016278:Ventricular Function, Right