TAPSE

TAPSE (Tricuspid Annular Plane Systolic Excursion) 

TAPSE is used to assess right ventricular (RV) longitudinal systolic function. In critical care, TAPSE is particularly useful because the RV contracts predominantly in the longitudinal direction, making longitudinal annular excursion an excellent surrogate of global RV systolic performance.

Definition

TAPSE = Distance (mm) that the lateral tricuspid annulus moves toward the cardiac apex during systole.

It measures longitudinal shortening of the RV.

Unlike LV, whose contraction is circumferential, radial and longitudinal, approximately 75–80% of RV stroke volume results from longitudinal shortening, which explains why TAPSE reflects RV systolic function reasonably well.

Why is TAPSE Important in ICU?

RV dysfunction is extremely common in critically ill patients.

Seen in

• Pulmonary embolism
• ARDS
• Septic shock
• Pulmonary hypertension
• RV infarction
• Chronic lung disease
• Post cardiac surgery
• ECMO patients
• Massive fluid overload
• Severe LV failure

Since RV failure dramatically increases mortality, TAPSE is routinely measured during focused critical care echo.

Limitations

Measures only Longitudinal function

NOT

• radial shortening
• circumferential shortening
• RVOT contraction

Therefore TAPSE may overestimate or underestimate true RV function.

Required Echo View

Apical Four-Chamber View (RV-focused if possible)

Ideal characteristics

• Entire RV visible
• RV apex not foreshortened
• Tricuspid annulus clearly seen
• LV and RV aligned vertically
• Minimal translation

RV-focused apical four-chamber gives highest accuracy.

Machine Mode-Use M-mode

Place M-mode cursor through Lateral tricuspid annulus

Cursor should be parallel to annular motion.

Guideline Cutoff(ASE/EACVI)—Normal ≥17 mm

Severity

TAPSE During Mechanical Ventilation

Positive pressure ventilation may decrease RV preload

TAPSE may decrease slightly.

Effect of PEEP

Increasing PEEP—RV preload↓—RV afterload↑—TAPSE may decrease Especially PEEP >10–15 cmH₂O.

Factors That Falsely Lower TAPSE

• Poor alignment of M-mode cursor
• RV infarction
• Severe tricuspid regurgitation (annular motion may not reflect effective forward systolic function)
• Mechanical ventilation
• High PEEP
• Large pericardial effusion
• Constrictive physiology
• Cardiac translation
• Post-cardiac surgery (pericardiotomy commonly reduces TAPSE despite preserved global RV function)

Factors That May Falsely Increase TAPSE

• Severe tricuspid regurgitation (hyperdynamic annular motion due to volume overload)
• Hyperdynamic circulation
• Young healthy individuals
• High preload

Common Pitfalls