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  • Title: Modified Tricuspid Annular Plane Systolic Excursion Using Transesophageal Echocardiography and Its Utility to Predict Postoperative Course in Heart Transplantation and Left Ventricular Assist Device Implantation.
    Author: Morita Y, Lencho T, Gunasekaran S, Modak R.
    Journal: J Cardiothorac Vasc Anesth; 2018 Jun; 32(3):1316-1324. PubMed ID: 29277303.
    Abstract:
    OBJECTIVES: Perioperative right ventricular (RV) function is important for determining the postoperative course in heart transplantation (HT) and left ventricular assist device (LVAD) implantation. The authors describe a modified tricuspid annular plane systolic excursion (m-TAPSE) using transesophageal echocardiography and assessed its clinical utility in HT and LVAD. DESIGN: Retrospective medical record review. SETTING: A single tertiary-care medical center. PARTICIPANTS: Forty-eight patients who underwent successful HT and 80 patients who underwent successful LVAD placement. MEASUREMENTS AND MAIN RESULTS: Statistically significant correlation between m-TAPSE and RV fractional area change (FAC) was seen for HT and LVAD (r = 0.462, p < 0.01 and r = 0.597, p < 0.01, respectively). For HT, receiver operating characteristics curve analysis yielded that m-TAPSE <0.64 cm provides 100% specificity and 57.1% sensitivity in predicting postoperative nitric oxide (NO) use, whereas RV FAC <24.1% provides 95.1% specificity and 71.4% sensitivity in predicting postoperative NO use (area under the curve 0.798 [95% confidence interval (CI), 0.595-1] v 0.826 [95% CI, 0.581-1], p = 0.397). For LVAD, m-TAPSE <0.71 cm provides 66.7% specificity and 87.5% sensitivity in predicting postoperative NO use, whereas RV FAC <16.3% provides 79.4% specificity and 62.5% sensitivity in predicting postoperative NO use (area under the curve 0.829 [95% CI, 0.732-0.927] v 0.691 [95% CI, 0.54-0.842], p < 0.05). CONCLUSIONS: m-TAPSE validated a good correlation to RV systolic function as reflected by RV FAC for both HT and LVAD. For HT, m-TAPSE was helpful for predicting postoperative NO use; whereas for LVAD, m-TAPSE was helpful for predicting postoperative NO use and RV assist device implantation. m-TAPSE should be considered as a useful parameter to decide postoperative management for these cases.
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