title: Tricuspid annular plane systolic excursion is reduced in infants with pulmonary hypertension.
abstract: BACKGROUND
  Right 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).
  
  
  METHODS
  Retrospective 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.
  
  
  RESULTS
  TAPSE 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 1 mm decrease in TAPSE (OR 1.78, 95% CI 1.26-2.45). Inter-observer agreement for TAPSE showed concordance correlation coefficient of 0.89.
  
  
  CONCLUSIONS
  TAPSE 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.
authors.affiliation: Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
authors.forename: Dala
authors.initials: D
authors.lastname: Zakaria
authors.forename: Ritu
authors.initials: R
authors.lastname: Sachdeva
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Gossett
authors.forename: Xinyu
authors.initials: X
authors.lastname: Tang
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: O'Connor
mesh_terms: D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging*; D007231:Infant, Newborn; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013599:Systole; D014261:Tricuspid Valve / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: TAPSE; children; echocardiography; pulmonary hypertension