Tricuspid annular plane systolic excursion by cardiac MRI has poor correlation with RVEF in...
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ORAL PRESENTATION Open Access Tricuspid annular plane systolic excursion by cardiac MRI has poor correlation with RVEF in pediatric patients Emem Usoro 2* , Jonathan H Soslow 1 , David Parra 1 From 16th Annual SCMR Scientific Sessions San Francisco, CA, USA. 31 January - 3 February 2013 Background Cardiovascular MRI (CMR) assessment of ventricular function in patients with RV pathology requires contour- ing the right ventricle, which can be time-consuming due to its abnormal shape and extensive trabeculations. A semi-quantitative method to assess RV function in this patient population would be beneficial and would allow for rapid reporting of results. A recent study demon- strated a high correlation of tricuspid annular plane systolic excursion as measured by CMR (MR-TAPSE) with RVEF in adult patients. In this study, we evaluated whether MR-TAPSE is a feasible alternative to assess RV function in children and young adults with a broad range of body surface areas (BSA). Methods A retrospective review from 2007-2012 identified: 49 patients with normal cardiac anatomy aged 18 years or under who underwent CMR (group 1), and 57 patients with Tetralogy of Fallot status post repair aged 18 years or under (group 2). Measurements of MR-TAPSE in group 1 were performed by three reviewers blinded to outcome. MR-TAPSE was measured in the four-chamber view of the cine MRI images. Agreement among reviewers was assessed using intraclass correlation coefficient (ICC). Linear regression analysis was used to assess MR-TAPSE prediction of RVEF. Results The mean age of patients was 14.9 ± 3.3 years (range 2.7- 18.8 years) in group 1 and 13.5 ± 3.4 years (range 4.3-18.9 years) in group 2. The mean BSA was 1.8 ± 0.4m2 (range 0.5-2.7m2) in group 1 and 1.4 ± 0.4m2 (range 0.7-2.3m2) in group 2. ICC demonstrated excellent correlation for individual TAPSE measures, suggesting low inter-observer variability (ICC 0.872 for diastole and ICC 0.784 for 2 Meharry Medical College, Nashville, TN, USA Full list of author information is available at the end of the article Figure 1 Indexed tricuspid annular plane systolic excursion by CMR (MR-TAPSE) had only moderate correlation with RVEF in group 1, or children and adolescents with normal CMR (A). Indexed MR-TAPSE had poor correlation with RVEF in group 2, or children and adolescents with Tetralogy of Fallot (B). Usoro et al. Journal of Cardiovascular Magnetic Resonance 2013, 15(Suppl 1):O40 http://www.jcmr-online.com/content/15/S1/O40 © 2013 Usoro et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Transcript of Tricuspid annular plane systolic excursion by cardiac MRI has poor correlation with RVEF in...
ORAL PRESENTATION Open Access
Tricuspid annular plane systolic excursion bycardiac MRI has poor correlation with RVEF inpediatric patientsEmem Usoro2*, Jonathan H Soslow1, David Parra1
From 16th Annual SCMR Scientific SessionsSan Francisco, CA, USA. 31 January - 3 February 2013
BackgroundCardiovascular MRI (CMR) assessment of ventricularfunction in patients with RV pathology requires contour-ing the right ventricle, which can be time-consumingdue to its abnormal shape and extensive trabeculations.A semi-quantitative method to assess RV function in thispatient population would be beneficial and would allowfor rapid reporting of results. A recent study demon-strated a high correlation of tricuspid annular planesystolic excursion as measured by CMR (MR-TAPSE)with RVEF in adult patients. In this study, we evaluatedwhether MR-TAPSE is a feasible alternative to assess RVfunction in children and young adults with a broad rangeof body surface areas (BSA).
MethodsA retrospective review from 2007-2012 identified: 49patients with normal cardiac anatomy aged 18 years orunder who underwent CMR (group 1), and 57 patientswith Tetralogy of Fallot status post repair aged 18 years orunder (group 2). Measurements of MR-TAPSE in group 1were performed by three reviewers blinded to outcome.MR-TAPSE was measured in the four-chamber view ofthe cine MRI images. Agreement among reviewers wasassessed using intraclass correlation coefficient (ICC).Linear regression analysis was used to assess MR-TAPSEprediction of RVEF.
ResultsThe mean age of patients was 14.9 ± 3.3 years (range 2.7-18.8 years) in group 1 and 13.5 ± 3.4 years (range 4.3-18.9years) in group 2. The mean BSA was 1.8 ± 0.4m2 (range
0.5-2.7m2) in group 1 and 1.4 ± 0.4m2 (range 0.7-2.3m2)in group 2. ICC demonstrated excellent correlation forindividual TAPSE measures, suggesting low inter-observervariability (ICC 0.872 for diastole and ICC 0.784 for
2Meharry Medical College, Nashville, TN, USAFull list of author information is available at the end of the article
Figure 1 Indexed tricuspid annular plane systolic excursion by CMR(MR-TAPSE) had only moderate correlation with RVEF in group 1, orchildren and adolescents with normal CMR (A). Indexed MR-TAPSEhad poor correlation with RVEF in group 2, or children andadolescents with Tetralogy of Fallot (B).
Usoro et al. Journal of Cardiovascular MagneticResonance 2013, 15(Suppl 1):O40http://www.jcmr-online.com/content/15/S1/O40
© 2013 Usoro et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.
systole). The average MR-TAPSE in group 1 had onlymoderate correlation with RVEF (r=0.3, p = 0.036) andonly mild improvement in correlation after normalizationwith BSA (r=0.42, p<0.05) (Figure 1A). RVEF in group 2did not correlate with either MR-TAPSE (r=0.027,p=0.844) or indexed MR-TAPSE (r=0.043, p=0.75)(Figure 1B).
ConclusionsAlthough MR-TAPSE has been found to be a reliablemethod of semi-quantification of RV function in adults,its use in the pediatric population may not be suitable,despite the fact that CMR provides better resolution andmore accurate delineation of the cardiac apex than2-dimensional echocardiography or M-mode. This maybe partially due to the significant variability in patientsize; in group 2, the poor correlation is also likelyrelated to RV dilatation and aneurysmal RVOT.
FundingNone.
Author details1Pediatrics, Division of Pediatric Cardiology, Vanderbilt University MedicalCenter, Nashville, TN, USA. 2Meharry Medical College, Nashville, TN, USA.
Published: 30 January 2013
doi:10.1186/1532-429X-15-S1-O40Cite this article as: Usoro et al.: Tricuspid annular plane systolicexcursion by cardiac MRI has poor correlation with RVEF in pediatricpatients. Journal of Cardiovascular Magnetic Resonance 2013 15(Suppl 1):O40.
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Usoro et al. Journal of Cardiovascular MagneticResonance 2013, 15(Suppl 1):O40http://www.jcmr-online.com/content/15/S1/O40
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