How to Measure Right Ventricular Function: TAPSE on Echocardiography

 

Measurement of Right Ventricular Function: TAPSE on Echocardiography

Tricuspid Annular Plane Systolic Excursion (TAPSE) is a simple, reproducible echocardiographic measurement used to assess right ventricular (RV) systolic function. It measures the longitudinal movement of the lateral tricuspid annulus toward the cardiac apex during systole. TAPSE is widely used because it is easy to obtain, requires minimal calculation, and is available on most echocardiography systems.

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What Is TAPSE?

TAPSE reflects the longitudinal contraction of the right ventricle. During systole, the lateral tricuspid annulus moves toward the apex. M-mode echocardiography records this movement, allowing the distance travelled by the annulus to be measured in millimetres.

Although TAPSE is a useful marker of RV systolic function, it primarily assesses longitudinal motion and should not be used as the sole measure of right ventricular performance.

Normal TAPSE Value

Normal TAPSE: >17 mm

A TAPSE of 17 mm or less is generally considered abnormal and may indicate reduced right ventricular systolic function.

Interpretation should consider image quality, loading conditions, rhythm, and the overall echocardiographic findings. A normal TAPSE does not exclude all forms of RV dysfunction.

How to Measure TAPSE: Step-by-Step Technique

Step 1: Obtain the Apical Four-Chamber View

Acquire a standard apical four-chamber view with clear visualization of the right ventricle and the lateral tricuspid annulus. Optimize the image to minimize foreshortening and ensure that the annulus is well defined.

Step 2: Position the M-Mode Cursor

Place the M-mode cursor through the lateral tricuspid annulus, ensuring that it is aligned as closely as possible with the direction of annular movement. Correct alignment is essential for an accurate measurement.

Step 3: Measure Annular Excursion

Record the M-mode tracing throughout the cardiac cycle. Measure the total longitudinal displacement of the lateral tricuspid annulus from its end-diastolic position to its maximal systolic position. Report the excursion in millimetres.

Practical tip: Measure the full systolic excursion rather than an arbitrary distance between waveform peaks. Ensure that the tracing and cursor alignment are adequate before interpreting the result.

Clinical Significance of TAPSE

TAPSE is particularly useful in the assessment of patients with suspected or established right ventricular dysfunction. It can support evaluation in the following settings:

• Pulmonary hypertension
• Right ventricular myocardial infarction
• Heart failure
• Significant tricuspid or pulmonary valve disease
• Congenital heart disease
• Assessment before and after cardiac surgery or selected interventions

In pulmonary hypertension and other conditions affecting the right ventricle, a reduced TAPSE may indicate impaired longitudinal systolic function and can have prognostic significance when interpreted in the appropriate clinical context.

Limitations of TAPSE

• Angle dependence: Incorrect M-mode cursor alignment may underestimate annular excursion.
• Load dependence: TAPSE can change with alterations in preload and afterload.
• Regional assessment: It reflects longitudinal motion at the lateral tricuspid annulus rather than global RV contraction.
• Postoperative changes: TAPSE may be reduced after cardiac surgery even when other measures of RV performance are relatively preserved.
• Limited standalone value: TAPSE should not be interpreted in isolation.

TAPSE Alongside Other Measures of RV Function

A comprehensive echocardiographic assessment of right ventricular function should integrate TAPSE with other measurements when feasible, including:

• RV fractional area change (FAC): Assesses the change in RV cavity area between diastole and systole.
• Tissue Doppler S′ velocity: Measures systolic velocity at the lateral tricuspid annulus.
• RV free-wall strain: Provides information about myocardial deformation.
• RV size and morphology: Helps identify dilatation and structural abnormalities.
• Additional parameters: Consider the clinical context, pulmonary pressures, tricuspid regurgitation, and other relevant findings.

Key Points for Clinical Practice

• Normal TAPSE: >17 mm.
• Use an apical four-chamber view.
• Place the M-mode cursor through the lateral tricuspid annulus, aligned with its motion.
• Measure systolic longitudinal annular excursion in millimetres.
• Interpret TAPSE alongside other RV functional parameters and the patient's clinical findings.

Conclusion

TAPSE is a practical and widely available echocardiographic parameter for assessing right ventricular longitudinal systolic function. With correct acquisition and cursor alignment, it provides a quick quantitative measurement that can support clinical decision-making. A value greater than 17 mm is generally considered normal; however, a comprehensive assessment of RV function requires integration with other echocardiographic parameters.

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Reference: Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. 2015;28:1–39.e14.

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