부산대학교 도서관

Background Current guidelines recommend the routine use of tricuspid annular plane systolic excursion ( TAPSE) as a simple method for estimating right ventricular ( RV) function. However, when ventricular apical longitudinal rotation (apical- LR) occurs in pulmonary hypertension ( PH) patients, it may result in overestimated TAPSE. Methods We studied 105 patients with PH defined as mean pulmonary artery pressure >25 mmHg at rest measured by right heart cardiac catheterization. TAPSE was defined as the maximum displacement during systole in the RV-focused apical four-chamber view. RV free-wall longitudinal speckle tracking strain ( RV-free) was calculated by averaging 3 regional peak systolic strains. The apical- LR was measured at the peak rotation in the apical region including both left and right ventricle. The eccentricity index ( EI) was defined as the ratio of the length of 2 perpendicular minor-axis diameters, one of which bisected and was perpendicular to the interventricular septum, and was obtained at end-systole ( EI-sys) and end-diastole ( EI-dia). Twenty age-, gender-, and left ventricular ejection fraction-matched normal controls were studied for comparison. Results The apical- LR in PH patients was significantly lower than that in normal controls (−3.4 ± 2.7° vs. −1.3 ± 1.9°, P = 0.001). Simple linear regression analysis showed that gender, TAPSE, EI-sys, and EI-dia/ EI-sys were associated with apical- LR, but RV-free was not. Multiple regression analysis demonstrated that gender, EI-dia/ EI-sys, and TAPSE were independent determinants of apical- LR. Conclusions TAPSE may be overestimated in PH patients with clockwise rotation resulting from left ventricular compression. TAPSE should thus be evaluated carefully in PH patients with marked apical rotation. [ABSTRACT FROM AUTHOR]