© 2015, Wiley Periodicals, Inc. DOI: 10.1111/echo.12898
LETTER TO THE EDITOR
Tricuspid Annular Plane Systolic Excursion Is Reduced in Infants with Pulmonary Hypertension Value of Tricuspid Annular Plane Systolic Excursion (TAPSE) to Determine Right Ventricular Function in Various Conditions of Pediatric Pulmonary Hypertension Dear Editor, With great interest, we read the article “Tricuspid annular plane systolic excursion is reduced in infants with pulmonary hypertension.”1 Zakaria et al.1 have studied right ventricular (RV) systolic function in infants with pulmonary hypertension (PH) due to bronchopulmonary dysplasia, congenital diaphragmatic hernia, or idiopathic PH. For assessment of RV systolic function, the tricuspid annular peak systolic excursion (TAPSE), the tricuspid annular peak systolic velocity (S0 ), and the RV fractional area change (FAC) were measured. Recently, data have been published on patients with chronic RV pressure overload, demonstrating impaired RV long-axis function consistent with myocardial damage.2 Impaired RV function in pediatric PH patients has been reported in previous studies.3–7 About half of the PH patients in childhood have an underlying congenital heart disease (CHD), which highlights the importance of noninvasive echocardiographic tools for the evaluation of the RV systolic function in these patients. The ﬁndings of Zakaria et al.1 in infants with PH due to bronchopulmonary dysplasia and congenital diaphragmatic hernia add up to data in PH-CHD patients.5,8 A reduction of S0 below the 2 SD of age-related normal values determines a reduced systolic RV function in children with PH.3 Recently reported studies on pediatric idiopathic PH, PH associated with autoimmune disease, and PH-CHD suggest that the systolic RV function progressively deteriorates over time.3–5 Zakaria et al.1 concluded that determination of the TAPSE is a promising technique to monitor infants with PH.1 We agree with their ﬁndings and want to emphasize the importance of echocardiographic evaluation of TAPSE values for longitudinal management of pediatric PH patients. For the convenience of the audience of echocardiography, we would like to mention that a comparison of their TAPSE and S0 data in infants with PH with published TAPSE and S0 pediatric normative values and z-scores would have
improved the statistical power of their analysis.9,10 In our opinion, it would also be of interest to investigate their PH patients in longitudinal follow-up examinations. With TAPSE values below the 2 SD of normal values, it could then be shown when systolic RV function deteriorates over time. This might emphasize the importance of their data for future pediatric PH follow-up examinations. We want to encourage the prospective use of echocardiography for routine assessment of RV systolic function in pediatric PH patients. Gernot Grangl, M.D.* Jasmin Pansy, M.D.† Ante Burmas, M.D.* and Martin Koestenberger, M.D., Ph.D.* *Department of Pediatrics, Division of Pediatric Cardiology, Medical University Graz, Graz, Austria †Department of Pediatrics, Division of Neonatology, Medical University Graz, Graz, Austria References 1. Zakaria D, Sachdeva R, Gossett JM, et al: Tricuspid annular plane systolic excursion is reduced in infants with pulmonary hypertension. Echocardiography 2015;32: 834–838. 2. Fang F, Henein MY, Yu C, et al: Right ventricular longaxis response to different chronic loading conditions: Its relevance to clinical symptoms. Int J Cardiol 2013;167: 378–382. 3. Koestenberger M, Nagel B, Ravekes W, et al: Tricuspid annular peak systolic velocity (S’) in children and young adults with pulmonary artery hypertension secondary to congenital heart diseases, and in those with repaired tetralogy of Fallot: Echocardiography and MRI data. J Am Soc Echocardiogr 2012;25:1041–1049. 4. Lammers AE, Haworth SG, Riley G, et al: Value of tissue Doppler echocardiography in children with pulmonary hypertension. J Am Soc Echocardiogr 2012; 25:504–510. 5. Kassem E, Humpl T, Friedberg MK: Prognostic signiﬁcance of 2-dimensional, M-mode, and Doppler echo indices of right ventricular function in children with
Letter to the Editor
pulmonary arterial hypertension. Am Heart J 2013;165: 1024–1031. 6. Di Maria MV, Younoszai AK, Mertens L, et al: RV stroke work in children with pulmonary arterial hypertension: Estimation based on invasive haemodynamic assessment and correlation with outcomes. Heart 2014;100:1342– 1347. 7. Vorhies EE, Gajarski RJ, Yu S, et al: Echocardiographic evaluation of ventricular function in children with pulmonary hypertension. Pediatr Cardiol 2014;35:759– 766. 8. Patel N, Mills JF, Cheung MM: Assessment of right ventricular function using tissue Doppler imaging in infants
with pulmonary hypertension. Neonatology 2009;96: 193–199. 9. 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– 719. 10. Koestenberger M, Nagel B, Ravekes W, et al: Reference values of tricuspid annular peak systolic velocity in healthy pediatric patients, calculation of z-score, and comparison to tricuspid annular plane systolic excursion. Am J Cardiol 2012;109:116–121.
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