Tricuspid Annular Motion Eskil Hammarstrom, MD, Bengt Wranne, MD," Fausto J. Pinto, MD,b Josephine Puryear, RDMS, and Richard L. Popp, MD, Stanford, California
Triscupid annular motion is related to right ventricular systolic function in the same way mitral annulus motion is related to left ventricular function. Tricuspid annular excursion reflects the longitudinal motion of the right ventricle, and the systolic descent of the anulus correlates with systolic venous inflow to the right atrium. However, it has not been shown clearly how to reproducibly quantify this motion. Therefore we describe a method to measure triscuspid annular motion using two-dimensional oriented M-mode echocardiography from the apical view. We studied a group of 10 normal subjects (mean age, 28.7 years; range, 25 to 38 years) and a group of 29 patients (mean age, 57.2 years; range, 20 to 84 years) with disease of the left side of the heart but no evidence of involvement of the right side of the heart. In each subject, tricuspid and mitral annular motion were measured respectively at their lateral, septal or medial, anterior, and posterior margin points. The total tricuspid annular motion for normal subjects was, as follows: lateral, 24.9 ± 3.5 mm; medial, 20.1 ± 2.5 mm; anterior, 21.6 ± 3.8 mm; and posterior, 22.3 ± 2.3 mm. Interobserver and intraobserver variability was low, with a coefficient of variance for the different annular points ranging from 6.19% to 11.56% between observers and from 4.10% to 7.26% within observer. We conclude that it is possible to measure tricuspid annular motion with this method in a reproducible way and to use it as a diagnostic tool in evaluating function of the right side of the heart. ( J AM Soc EcHo 1991;4:131-9.) .
Filling and emptying of the normal heart occurs almost without changes in total heart volume. 1. 3 When the ventricles contract, the anuli descend to ward the apex, which is almost stationary/· 3· 9 and, combined with myocardial thickening, the volume ofthe ventricles decreases as blood is ejected into the great vessels. The onset of annular movement in sys tole occurs at the beginning of isovolumetric con traction when the ventricles change shape abruptly. 4 This excursion reaches its maximum point at the end of the ejection period, 10-u leading to an increase in atrial volume 1· 3 concomitant with the decrease in ven tricular size. Consequently, blood is transported into the atria from the great veins and total heart volume is maintained.
From the Cardiology Division, Stanford University School of Medicine. Reprint requests: Richard L. Popp, MD, Cardiology Division, Stanford University Medical Center, Stanford, CA 94305. 'Supported by grants from the Swedish Medical Research Council, Swedish Medical Association, Swedish Heart Lung Foundation (Stockholm, Sweden), and the Fulbright Commission. 'Supported by a Research Fellowship of the Funda