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The association between the configuration of tricuspid annular plane systolic excursion and right atrial contractile strain
Affiliations- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
open access
Abstract
Background: In the descending arm of tricuspid annular plane systolic excursion (TAPSE), there is notch formation that corresponds to the contractile phase of the atrial strain curve. Theoretically, this notch formation stands for atrial contraction.
Aims: We aim to characterize notch formation on TAPSE, predictors of its existence, and its relationship with the right ventricle and right atrial strain (RAS) parameters.
Methods: Retrospectively selected 240 patients were investigated for the determinants of notch formation on TAPSE and the relationship between RAS and TAPSE. RAS was analyzed using 2D speckle tracking in a dedicated mode for atrial analysis and reported separately for the reservoir, conduit, and contractile phases.
Results: 71.7% ( n = 172) of patients had notch formation on TAPSE and 70.4% (n = 169) had a normal value of right atrial contractile strain (RASct). Most patients with notch formation also had preserved RASct (95.9%; P <0.001). In multivariable analysis, RASct (odds ratio [OR], 1.45; 95% confidence interval [CI]: 1.13–1.77; P = 0.020) remained significant with notch formation. Receiver operator characteristic (ROC) analysis demonstrated that a RASct of –19% was a cut-off for the presence of notch formation. ROC area was 0.897 (95% CI 0.844–0.951; P <0.001).
Conclusions: The changes in TAPSE configuration reflect the changes in the atrial contractile phase. The descending arm of TAPSE indicates RASct as to whether it is preserved or not. Notch formation persists if RASct is above –19%. So, an easier, more applicable, and more effortless tool, TAPSE, can be used as an indicator of the atrial contractile phase by its configuration in daily routine.
Abstract
Background: In the descending arm of tricuspid annular plane systolic excursion (TAPSE), there is notch formation that corresponds to the contractile phase of the atrial strain curve. Theoretically, this notch formation stands for atrial contraction.
Aims: We aim to characterize notch formation on TAPSE, predictors of its existence, and its relationship with the right ventricle and right atrial strain (RAS) parameters.
Methods: Retrospectively selected 240 patients were investigated for the determinants of notch formation on TAPSE and the relationship between RAS and TAPSE. RAS was analyzed using 2D speckle tracking in a dedicated mode for atrial analysis and reported separately for the reservoir, conduit, and contractile phases.
Results: 71.7% ( n = 172) of patients had notch formation on TAPSE and 70.4% (n = 169) had a normal value of right atrial contractile strain (RASct). Most patients with notch formation also had preserved RASct (95.9%; P <0.001). In multivariable analysis, RASct (odds ratio [OR], 1.45; 95% confidence interval [CI]: 1.13–1.77; P = 0.020) remained significant with notch formation. Receiver operator characteristic (ROC) analysis demonstrated that a RASct of –19% was a cut-off for the presence of notch formation. ROC area was 0.897 (95% CI 0.844–0.951; P <0.001).
Conclusions: The changes in TAPSE configuration reflect the changes in the atrial contractile phase. The descending arm of TAPSE indicates RASct as to whether it is preserved or not. Notch formation persists if RASct is above –19%. So, an easier, more applicable, and more effortless tool, TAPSE, can be used as an indicator of the atrial contractile phase by its configuration in daily routine.
Keywords
atrial contractile strain, right atrial strain, tricuspid annular plane systolic excursion
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About this articleTitle
The association between the configuration of tricuspid annular plane systolic excursion and right atrial contractile strain
Journal
Kardiologia Polska (Polish Heart Journal)
Issue
Article type
Original article
Pages
141-149
Published online
2022-11-30
Page views
343
Article views/downloads
83
DOI
10.33963/KP.a2022.0273
Bibliographic record
Kardiol Pol 2023;81(2):141-149.
Keywords
atrial contractile strain
right atrial strain
tricuspid annular plane systolic excursion
Authors
Sena Sert
Lale Dinç Asarcıklı
Mehmet Fatih Yılmaz
Levent Pay
Aycan Esen Zencirci
Aysel Yağmur
Barış Güngör
Özlem Yıldırımtürk
References (32)- Tadic M. The right atrium, a forgotten cardiac chamber: An updated review of multimodality imaging. J Clin Ultrasound. 2015; 43(6): 335–345.
- Chow V, Ng AC, Chung T, et al. Right atrial to left atrial area ratio on early echocardiography predicts long-term survival after acute pulmonary embolism. Cardiovasc Ultrasound. 2013; 11: 17.
- Raymond RJ, Hinderliter AL, Willis PW, et al. Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol. 2002; 39(7): 1214–1219.
- Sallach JA, Tang WH, Borowski AG, et al. Right atrial volume index in chronic systolic heart failure and prognosis. JACC Cardiovasc Imaging. 2009; 2(5): 527–534.
- Nemes A, Forster T. [Echocardiographic evaluation of the right atrium - from M-mode to 3D speckle-tracking imaging]. Orv Hetil. 2016; 157(43): 1698–1707.
- Lang RM, Cameli M, Sade LE, et al. Imaging assessment of the right atrium: anatomy and function. Eur Heart J Cardiovasc Imaging. 2022; 23(7): 867–884.
- Rai AB, Lima E, Munir F, et al. Speckle tracking echocardiography of the right atrium: the neglected chamber. Clin Cardiol. 2015; 38(11): 692–697.
- Badano LP, Kolias TJ, Muraru D, et al. Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018; 19(6): 591–600.
- Miller D, Farah MG, Liner A, et al. The relation between quantitative right ventricular ejection fraction and indices of tricuspid annular motion and myocardial performance. J Am Soc Echocardiogr. 2004; 17(5): 443–447.
- 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(7): 685–713; quiz 786.
- Soulat-Dufour L, Addetia K, Miyoshi T, et al. Normal Values of Right Atrial Size and Function According to Age, Sex, and Ethnicity: Results of the World Alliance Societies of Echocardiography Study. J Am Soc Echocardiogr. 2021; 34(3): 286–300.
- Voigt JU, Pedrizzetti G, Lysyansky P, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(1): 1–11.
- Hasselberg NE, Kagiyama N, Soyama Y, et al. The prognostic value of right atrial strain imaging in patients with precapillary pulmonary hypertension. J Am Soc Echocardiogr. 2021; 34(8): 851–861.e1.
- Vos JL, Leiner T, van Dijk APJ, et al. Right atrial and ventricular strain detects subclinical changes in right ventricular function in precapillary pulmonary hypertension. Int J Cardiovasc Imaging. 2022 [Epub ahead of print].
- Khedr L, Elasfar A, Hekal S, et al. Assessment of left and right atrial geometrical changes in patients with stable coronary artery disease: Left and right atrial strain and strain rate imaging study. Egypt Heart J. 2018; 70(2): 101–106.
- Vakilian F, Tavallaie A, Alimi H, et al. Right atrial strain in the assessment of right heart mechanics in patients with heart failure with reduced ejection fraction. J Cardiovasc Imaging. 2021; 29(2): 135–143.
- D'Ascenzi F, Cameli M, Padeletti M, et al. Characterization of right atrial function and dimension in top-level athletes: a speckle tracking study. Int J Cardiovasc Imaging. 2013; 29(1): 87–94.
- Olsen FJ, Biering-Sørensen T. Right atrial strain: Tapping into a new reservoir of hemodynamic information. Int J Cardiol. 2021; 326: 226–228.
- Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37(27): 2129–2200.
- Hu R, Mazer CD, Tousignant C. Relationship between tricuspid annular excursion and velocity in cardiac surgical patients. J Cardiothorac Vasc Anesth. 2014; 28(5): 1198–1202.
- Addetia K, Takeuchi M, Maffessanti F, et al. Simultaneous longitudinal strain in all 4 cardiac chambers: a novel method for comprehensive functional assessment of the heart. Circ Cardiovasc Imaging. 2016; 9(3): e003895.
- Solomon SD, Biering-Sørensen T. LA strain when ejection fraction is preserved: a new measure of diastolic function? JACC Cardiovasc Imaging. 2017; 10(7): 744–746.
- Ersbøll M, Andersen MJ, Valeur N, et al. The prognostic value of left atrial peak reservoir strain in acute myocardial infarction is dependent on left ventricular longitudinal function and left atrial size. Circ Cardiovasc Imaging. 2013; 6(1): 26–33.
- Barbier P, Solomon S, Schiller N, et al. Left atrial relaxation and left ventricular systolic function determine left atrial reservoir function. Circulation. 1999; 100(4): 427–436.
- Truong VT, Palmer C, Young M, et al. Right atrial deformation using cardiovascular magnetic resonance myocardial feature tracking compared with two-dimensional speckle tracking echocardiography in healthy volunteers. Sci Rep. 2020; 10(1): 5237.
- Qu YY, Buckert D, Ma GS, et al. Quantitative assessment of left and right atrial strains using cardiovascular magnetic resonance based tissue tracking. Front Cardiovasc Med. 2021; 8: 690240.
- Bierig S, Hill J. Echocardiographic evaluation of diastolic function. Journal of Diagnostic Medical Sonography. 2011; 27(2): 65–78.
- Pathan F, D'Elia N, Nolan MT, et al. Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr. 2017; 30(1): 59–70.e8.
- Padeletti M, Cameli M, Lisi M, et al. Reference values of right atrial longitudinal strain imaging by two-dimensional speckle tracking. Echocardiography. 2012; 29(2): 147–152.
- Peluso D, Badano LP, Muraru D, et al. Right atrial size and function assessed with three-dimensional and speckle-tracking echocardiography in 200 healthy volunteers. Eur Heart J Cardiovasc Imaging. 2013; 14(11): 1106–1114.
- Brand A, Bathe M, Hübscher A, et al. Normative reference data, determinants, and clinical implications of right atrial reservoir function in women assessed by 2D speckle-tracking echocardiography. Echocardiography. 2018; 35(10): 1542–1549.
- Vîjîiac A, Vătășescu R, Onciul S, et al. Right atrial phasic function and outcome in patients with heart failure and reduced ejection fraction: Insights from speckle-tracking and three-dimensional echocardiography. Kardiol Pol. 2022; 80(3): 322–331.
