Clinical Investigation
Echocardiographic Reference Values in Children and Adults
Right Ventricular Function in Infants, Children and Adolescents: Reference Values of the Tricuspid Annular Plane Systolic Excursion (TAPSE) in 640 Healthy Patients and Calculation of z Score Values

https://doi.org/10.1016/j.echo.2009.03.026Get rights and content

Background

Tricuspid annular plane systolic excursion (TAPSE) is an echocardiographic measurement to assess right ventricular systolic function in adults. The aim of this study was to determine growth-related changes in TAPSE to establish references values.

Methods

A prospective study was conducted in a group of 640 healthy pediatric patients (age range, 1 day to 18 years; body surface area range, 0.12-2.25 m2). The effects of age and body surface area on TAPSE were determined.

Results

TAPSE ranged from a mean of 0.91 cm (z score ± 3, 0.56-1.26 cm) in neonates to 2.47 cm (z score ± 3, 1.84-3.10 cm) in 18-year-olds. TAPSE values showed positive correlations with age and body surface area. There was no significant difference in TAPSE values between female or male children.

Conclusion

In this study, z scores of TAPSE values were calculated and percentile charts were established to serve as reference data for ready application in patients with congenital heart disease in the future.

Section snippets

Patient Population

The patients were selected from healthy individuals referred to our cardiology service for evaluation of heart murmurs or family histories of heart disease. The study group consisted of 640 pediatric patients (348 male, 292 female) with normal echocardiographic results. The study group encompassed neonates to adolescents (age range, 1 day to 18 years; BSA range, 0.12-2.25 m2), including 41 neonates and 87 infants. For the purposes of the study, only echocardiograms with official readings of

Results

TAPSE, age, and BSA were strongly correlated: Spearman's rank correlation coefficients were 0.93 for age and TAPSE, 0.97 for age and BSA, and 0.93 for BSA and TAPSE. Adjusting for the strong correlation between age and TAPSE, the partial correlation between BSA and TAPSE was 0.31. This shows a minor additional impact of BSA for the TAPSE values. TAPSE ranged from a mean of 0.91 cm (z score ± 3, 0.56-1.26 cm) in neonates to 2.47 cm (z score ± 3, 1.84-3.10 cm) in 18-year-olds (Table 1). TAPSE

Discussion

Our intention was to assess a method that can be easily applied but is reliable to provide a quick assessment of RV function. Recent publications have shown that TAPSE measurement is more reproducible than other echocardiographic indices of RV function5, 10 and has high specificity and negative predictive power for detecting abnormal RV systolic function in adults.3, 13, 14 TAPSE is much easier to measure than RV ejection fraction in clinical practice. This parameter can therefore be considered

Conclusion

We have established normal reference values of TAPSE in the pediatric age group with respect to age and BSA that could serve as a reference database for ready application in pediatric patients with CHD and acquired RV and LV dysfunction. In the future, TAPSE measurements may be included in the battery of echocardiographic markers in patients with CHD, especially in those with expected decreased RV function.

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