Validation of Tricuspid Annular Displacement by Tissue Doppler in Pulmonary Hypertension

Figures

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  Figure 1. Echocardiographic measurements of TAPSE (a), TAPSE‐TDI and RV s′ (b) in a representative subject. (a) The yellow arrow indicates TAPSE, representing the maximum apical excursion of the basal right ventricular free wall segment in systole by M‐mode. (b) Yellow lines illustrate the velocity time integral of systolic or diastolic signal on tricuspid annular tissue Doppler imaging. Yellow dot indicates RV s′. Abbreviations: TAPSE, tricuspid annular plane systolic excursion; TDI, tissue Doppler imaging.

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  Figure 2. Comparing TAPSE and TAPSE‐TDI. (a) Quantile regression of TAPSE and TAPSE‐TDI. (b) Residual analysis of TAPSE and TAPSE‐TDI. (c) Compared with TAPSE, the quantitative metrics of TAPSE‐TDI and systolic TDI. *All relationships presented are significant p < 0.001. Bias is reported for the median value. Abbreviations: ICC, intraclass correlation coefficient; RMSE, root mean square error; TAPSE, tricuspid annular plane systolic excursion; TAPSE‐TDI, tissue Doppler imaging‐derived TAPSE using velocity time integral.

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  Figure 3. Receiver operator characteristic (ROC) curves for discriminating right heart catheterization‐confirmed pulmonary hypertension (mPAP > 20 mmHg). (a) Diagnostic performance of TAPSE (AUC = 0.849, 95% CI: 0.817–0.880), TAPSE‐TDI (AUC = 0.841, 95% CI: 0.810–0.873), and RV s′ (AUC = 0.677, 95% CI: 0.634–0.719) using right heart catheterization as the reference standard. (b) Diagnostic performance of systolic TDI (AUC = 0.835, 95% CI: 0.802–0.868) and diastolic TDI (AUC = 0.846, 95% CI: 0.814–0.877) for identifying pulmonary hypertension. Abbreviations: AUC, area under the curve; mPAP, mean pulmonary artery pressure; ROC, receiver operator characteristic; RV, right ventricular; TAPSE, tricuspid annular plane systolic excursion; TAPSE‐TDI, TDI derived TAPSE using velocity time integral; TDI, tissue Doppler imaging.

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  Figure 4. CART analysis: TAPSE‐TDI for the diagnosis of pulmonary hypertension. Abbreviations: CART, classification and regression tree; PR, probability rate of pulmonary hypertension; RV, right ventricular; TAPSE‐TDI, tissue Doppler imaging‐derived TAPSE using velocity time integral.

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  Figure 5. ROC curve of RVSP, TAPSE/RVSP ratio, and TAPSE‐TDI/RVSP ratio in detecting pulmonary hypertension confirmed by right heart catheterization (mPAP > 20 mmHg). (a) TAPSE (AUC = 0.866, 95% CI: 0.835–0.897), RVSP (AUC = 0.945, 95% CI: 0.926–0.963), and TAPSE/RVSP ratio (AUC = 0.971, 95% CI: 0.959–0.983). (b) TAPSE‐TDI (AUC = 0.855, 95% CI: 0.823–0.887), RVSP (AUC = 0.945, 95% CI: 0.926–0.964), and TAPSE‐TDI/RVSP ratio (AUC = 0.968, 95% CI: 0.955–0.980). Abbreviations: AUC, area under the curve; mPAP, mean pulmonary artery pressure; ROC, receiver operator characteristic; RVSP, right ventricular systolic pressure; TAPSE, tricuspid annular plane systolic excursion; TAPSE‐TDI, tissue Doppler imaging‐derived TAPSE using velocity time integral.

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  Figure 6. CART analysis: TAPSE/RVSP for the diagnosis of pulmonary hypertension. Abbreviations: CART, classification and regression tree; PR, probability rate of pulmonary hypertension; RVSP, right ventricular systolic pressure; TAPSE, tricuspid annular plane systolic excursion.