Exercise-Related Change of TAPSE and the Tricuspid Annular Movement Velocity in M-Mode Echocardiography in Patients with the Corrected Tetralogy of Fallot

Objectives: There are poorly predictive parameters for an irreversibly right heart failure due to regurgitation and right ventricular (RV) dilatation common after Fallot’s repair. Tricuspid annular plane systolic excursion (TAPSE) has been proven as a good corelative to RV function. The aim of the study was to investigate the changes of the TAPSE and the TAPSE Velocity in echocardiographic assessment during exercise stress testing in these patients compared with healthy subjects.

Methods:16 patients (12 male; mean age, 13.13 ± 6.46 years) with asymptomatic impaired RV systolic function and 15 healthy subjects (5 male; mean age, 14 ± 6.79) were enrolled. All subjects underwent a semisuspine bycicle stress echocardiography (sBEE), up to six levels of resistance increasing every 2 minutes and 2 minutes of recovery. All participants started at 20 Watt (W), the increase was calculated with 0.5 W/kg body weight with a maximal increase of 20 W per stage. At 2 minutes at every stage an echocardiographic assessment consisting of a four-chamber view and the M-mode through the tricuspid valve were recorded. TAPSE and TAPSE velocity were measured. The mean value of five measurements at each stage was used. Differences between groups were tested using Mann–Whitney U-test with a critical value of U = 70. Statistical significance was assumed for p < 0.05. Data analysis was performed with SPSS.

Result: Data of both groups for TAPSE and gradient of TAPSE at rest, stage 7, peak load and recovery showed normal distribution. There was no significant difference in the amount of stages reached by both groups (mean, 5.38 ± 1.11 vs. 5.80 ± 1.38). The increase of both parameters from rest to peak load was significant higher in the healthy group (TAPSE: healthy group 8.49 ± 4.66 mm, patients 4.43 ± 3.01 mm, U-value = 66 ; TAPSE velocity: healthy group 7.96 ± 2.93 mm/s, patients 3.14 ± 1.57 mm/s, U-value = 11) with TAPSE velocity being the more sensitive parameter. (Cohens d TAPSE = 1.03, gradient of TAPSE = 2.05) The peak load stage showed the highest difference between groups in TAPSE and Gradient of TAPSE. Thus, the statistical significance of difference of TAPSE Velocity versus TAPSE alone increased with exercise in both groups.

Conclusion: Increase of TAPSE and TAPSE Velocity during sBEE was significant lower in patients after Fallot’s repair. The more useful parameter to differentiage normal right-ventricular performance is TAPSE Velocity.