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Fetal Tricuspid Annular Plane Systolic Excursion (F-TAPSE): Evaluation of fetal right heart systolic function with conventional M-mode and STIC M-mode.
MedLine Citation:
PMID:  23288668     Owner:  NLM     Status:  Publisher    
Background: Fetal tricuspid annular plane systolic excursion (f-TAPSE) is a modified method to measure the vertical movement of the tricuspid valve annulus by M-mode to assess the fetal right heart. It is well-recognized in pediatric and adult cardiology to evaluate right heart function, but has not been widely studied in the fetus. We aimed to study f-TAPSE in the second half of gestation in normal fetuses, to establish reference ranges for this measure, to evaluate the usefulness of STIC-M-mode in obtaining TAPSE, and to compare conventional and STIC M-mode based measures of TAPSE. Methods Gravidae presenting to our centers from 20-38 weeks for targeted organ scans, fetal echocardiography, or 3(rd) trimester fetal surveillance, with structurally normal singleton fetuses and verified gestational age (GA) were recruited. During the booked scan in addition to standard biometry, M-mode was applied to the tricuspid annulus, parallel to the ventricular septum, and the amplitude of the resulting wave was measured. To allow comparison with STIC M-mode, a STIC volume was acquired and saved. In post-processing, the volume was rotated to show an apical 4CV, and f-TAPSE was investigated in similar fashion to conventional M-mode. Two-three measures of TAPSE were taken and the results averaged. Thirty measurements were performed by two observers and inter- and intra-observer variations were calculated. Results 341 fetuses were examined at GA 20-39 weeks. Conventional M-mode f-TAPSE values ranged from a mean of 4.1 mm ( ± 0.85) at 21 weeks to a mean of 8.3 mm ( ± 0.34) at 39 weeks. In 16 cases we were unable to perform the conventional M-mode owing to fetal lie; in 8 cases STIC volumes were found in post-processing to be unsuitable for analysis. STIC f-TAPSE ranged from a mean of 4.2mm ( ± 1.4) at 21 wks to a mean of 8.6 ( ± 1.6) at 39 wks. Scatterplots of f-TAPSE measures obtained with conventional M-mode and with STIC M-mode were created, vs. GA and estimated fetal weight (EFW). In both modalities f-TAPSE increased linearly with GA and with EFW. Good correlation was found between the two methods (Pearson's R(2) = 0.904). No significant difference was found in mean or variance of the distribution or slope of the regression equation. Inter- and intra-observer variation (ICC) in both conventional and STIC f-TAPSE were 0.94 and 0.97, respectively. Conclusion: F-TAPSE in normal fetuses increases over the course of gestation and correlates to EFW. F-TAPSE is easy to perform and available on all ultrasound machines; STIC f-TAPSE is available on machines equipped with this modality and produces similar measures with greater success rate. We suggest the addition of f-TAPSE to fetal right cardiac functional evaluation. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Baruch Messing; Yinon Gilbo'a; Michal Lipschuetz; Dan V Valsky; Sarah M Cohen; Simcha Yagel
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-3
Journal Detail:
Title:  Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology     Volume:  -     ISSN:  1469-0705     ISO Abbreviation:  Ultrasound Obstet Gynecol     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9108340     Medline TA:  Ultrasound Obstet Gynecol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
Departments of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel; Departments of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel.
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