© 2015, Wiley Periodicals, Inc. DOI: 10.1111/echo.12974
Tricuspid Annular Plane Systolic Excursion and Its Association with Mortality in Critically Ill Patients Right Ventricular Function in Critically Ill Patients Dear Editor, We read with great interest the article “Tricuspid Annular Plane Systolic Excursion and Its Association with Mortality in Critically Ill Patients” written by Gajanana et al.1 They aimed to explore whether right ventricular (RV) dysfunction can occur under the conditions of extreme emotional or physiological stress. They concluded that RV systolic function, as assessed by tricuspid annular plane systolic excursion (TAPSE), has important prognostic value in critically ill patients. We believe these ﬁndings will act as a guide for further studies in this ﬁeld. Right ventricular myocardial performance is of paramount importance in various disease conditions and has a prognostic value in heart failure, pulmonary hypertension, pulmonary embolism, congenital heart disease, and myocardial infarction.2 RV systolic performance is a reﬂection of contractility, preload and afterload. Echocardiographic assessment of the RV has been largely qualitative, because of the difﬁculty in assessing RV volumes because of its unusual geometric shape.3 RV function can be assessed echocardiographically using several parameters including RV myocardial performance index (RV MPI), TAPSE, myocardial acceleration during isovolumic contraction (RV IVA), RV fractional area change (RV FAC), three-dimensional ejection fraction (3D RVEF), as well as tissue Dopplerderived tricuspid lateral annular systolic velocity (Tri S), longitudinal strain, and strain rate.4 Tricuspid valve annular velocity measured by tissue Doppler imaging has a potential for the evaluation of RV function in patients with pulmonary and congenital heart diseases.5,6 It represents a simple, reproducible technique in the assessment of RV function and does not need additional
software. In the current study, the authors assessed RV function using only TAPSE in critically ill patients. We believe further studies should be conducted to assess other quantitative parameters of RV function in these patients. Sait Demirkol, M.D., Cengiz Ozturk, M.D., Murat Unlu, M.D., Zekeriya Arslan, M.D., and Turgay Celik, M.D. Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey References 1. Gajanana D, Seetha Rammohan H, Alli O, et al: Tricuspid annular plane systolic excursion and its association with mortality in critically ill patients. Echocardiography 2015; 32:1222–1227. 2. Haddad F, Hunt SA, Rosenthal DN, et al: Right ventricular function in cardiovascular disease, part I: anatomy, physiology, aging, and functional assessment of the right ventricle. Circulation 2008;117:1436–1448. 3. Jurcut R, Giusca S, La Gerche A, et al: The echocardiographic assessment of the right ventricle: what to do in 2010? Eur J Echocardiogr 2010;11:81–96. 4. Rudski LG, Lai WW, Aﬁlalo J, et al: Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685–713. 5. Turhan S, Dincßer I, Ozdol C, et al: Value of tissue Doppler myocardial velocities of tricuspid lateral annulus for the diagnosis of right heart failure in patients with COPD. Echocardiography 2007;24:126–133. 6. Cetin I, Tokel K, Varan B, et al: Evaluation of right ventricular function by using tissue Doppler imaging in patients after repair of tetralogy of fallot. Echocardiography 2009;26:950–957.