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083 Annulo-apical angles and tapse to rapidly assess right ventricular systolic function: a cardiac magnetic resonance study
  1. S A Zakeri,
  2. A N Borg,
  3. M Schmitt
  1. Cardiovascular Division, University Hospital of South Manchester, Manchester, UK


Background Volumetric assessment of the right ventricle (RV) by Cardiac Magnetic Resonance (CMR), albeit time-consuming, provides accurate and reproducible measurement of RV ejection fraction (RVEF). Tricuspid annulus peak systolic excursion (TAPSE) is a predominantly Echo-validated rapidly—derived surrogate of RV function. Correlations between RVEF and systolic changes in annulo-apical angles (AAAs) have not previously been evaluated.

Objective To assess the use of changes in AAAs and TAPSE as rapidly-derived surrogate markers of RV systolic function using CMR.

Methods We measured RV volumes from short-axis bSSFP stacks in patients undergoing clinically indicated CMR scans. RVEF was calculated from volumes derived by semi-automated endocardial contouring (QMass®MR 7.2). AAAs (α, β, θ angles—see Abstract 083 figure 1), subtended by a triangle connecting the medial and lateral extent of the tricuspid valve annulus and RV apex, and fractional changes in AAAs (ΔAAA/EDAAA×100, whereby ΔAAA=EDAAA−ESAAA) were measured from end-diastolic (ED) and end-systolic (ES) 4chamber SSFP cine still frames. TAPSE was measured as the change in length of a line connecting the lateral tricuspid valve annulus with the RV apex from ED to ES. Parameters were compared with RVEF using Spearman rank correlations; ROC curves constructed to assess accuracy of the parameters in predicting an RVEF<50%.

Abstract 083 Figure 1

Top: AAAs in ED on a 4 chamber view. Bottom: ROC curve analysis.

Results 40 subjects were included: 10 normals, 10 mildly-impaired, 10 moderately-impaired, and 10 with severely-impaired RV systolic function. Median (25th–75th percentile) RVEF for each subgroup was 53.5% (51.4%–55.7%), 41.5% (38.1%–47.2%), 30.0% (21.7%–33.5%), and 15.8% (9.6%–21.2%), respectively. Correlations with RVEF: TAPSE (0.74, p<0.001), fractional changes of α angle (0.64, p<0.001), β angle (–0.39, p<0.05), and θ angle, which had the highest correlation (–0.77, p<0.001). Smaller increases or a decrease in magnitude of the θ angle from ED to ES are associated with lower RVEFs, whereby a fractional θ angle change of ≥ –25.5% predicts RVEF<50% [97% sensitivity, 91% specificity, AUC=0.98]. The cut-off for TAPSE is ≤1.87 cm [100% sensitivity, 82% specificity, AUC=0.98]. Intra- and inter-observer reproducibility is excellent as shown by intra-class correlation coefficients for TAPSE (0.98 and 0.87, respectively) and fractional θ angle change (0.96 and 0.94, respectively).

Conclusion Both fractional θ angle change and TAPSE strongly correlate with RVEF, and are accurate predictors of RVEF<50%. These measurements provide an excellent alternative to the more time-consuming derivation of RVEF obtained volumetrically by endocardial chamber tracing.

Abstract 083 Figure 2

Scatter graphs for fractional θ angle change and TAPSE, both plotted against RVEF. Dotted vertical lines represent the ROC cut-offs of RVEF<50%. Dashed horizontal lines represent cut-offs of ≥ –25.5% and ≤1.87 cm for fractional θ angle change and TAPSE, respectively.

  • Tricuspid annulus peak systolic excursion
  • annulo-apical angle
  • right ventricular ejection fraction

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