Pediatrics International (2015) 57, 193
Letter to the Editor
Racial differences of the tricuspid annular plane systolic excursion Martin Koestenberger, Gernot Grangl and Ante Burmas Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria
We read with interest the article “Z-values of tricuspid annular plane systolic excursion in Japanese children” by Hashimoto et al.1 This is an excellent statement describing the need for investigation of racially dependent differences of the tricuspid annular plane systolic excursion (TAPSE) and for a more detailed investigation of right ventricular (RV) function in children. We want to highlight that the authors additionally determined the left ventricular (LV) shortening fraction and mitral annular plane systolic excursion to investigate a possible influence of LV function on normal TAPSE values. The authors used RV stroke volume (SV)/body surface area (BSA) as an independent indicator of body size.1 Given that this parameter is determined by the pulmonary blood flow velocity and the diameter of the pulmonary orifice in the RV outflow tract (RVOT), we may state that the RVOT proximal diameter has been shown to be an age-dependent parameter.2 Using available age-related values in their statistical analysis would perhaps result in a higher significant correlation between TAPSE and RVSV/BSA then was observed in their study.1 In a different study it was shown that normal RV contraction pattern shifts from the radial to longitudinal direction (by measuring the TAPSE) in healthy children.3 Their finding that TAPSE plays a major role in the generation of RV output is in good agreement with various other studies.4,5 In our opinion it would be of interest to include RVOT systolic excursion (SE) in studies on the relationship of BSA and longitudinal RV function, for example by using available RVOT SE normative pediatric Correspondence: Martin Koestenberger, MD, Department of Pediatrics; Medical University Graz, Auenbruggerplatz 30, A-8036 Graz, Austria. Email: [email protected]
Received 16 September 2014; accepted 29 October 2014.
© 2015 Japan Pediatric Society
data.6 RVOT SE, when used in combination with, for example, TAPSE, provides a comprehensive assessment of RV systolic function.6 We want to thank the authors for addressing the current need for a careful and systematic evaluation of RV systolic function using TAPSE in childhood, paying particular attention to potential racial differences in the correct interpretation of normal pediatric TAPSE. Their current work1 will enhance the knowledge on normal RV systolic function pattern in childhood.
References 1 Hashimoto I, Watanabe K, Kaneda H. Z-values of tricuspid annular plane systolic excursion in Japanese children. Pediatr. Int. 2014. doi: 10.1111/ped.12491. [Epub ahead of print.] 2 Koestenberger M, Avian A, Ravekes W. Reference values of the right ventricular outflow tract (RVOT) proximal diameter in 665 healthy children and calculation of Z-score values. Int. J. Cardiol. 2013; 169: e99–101. 3 Hashimoto I, Watanabe K. Alternation of right ventricular contraction pattern in healthy children. Circ. J. 2014; 78: 1967–73. 4 Koestenberger M, Ravekes W, Everett AD et al. 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. J. Am. Soc. Echocardiogr. 2009; 22: 715–19. 5 Sato T, Tsujino I, Ohira H et al. Validation study on the accuracy of echocardiographic measurements of right ventricular systolic function in pulmonary hypertension. J. Am. Soc. Echocardiogr. 2012; 25: 280–86. 6 Koestenberger M, Ravekes W, Nagel B et al. Reference values of the right ventricular outflow tract systolic excursion in 711 healthy children and calculation of z-score values. Eur. Heart J. Cardiovasc. Imaging 2014; 15: 980–86.
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