not applicable, this is Letter to Editor
Research Article
Normal Values of MAPSE and TAPSE in the Paediatric Population Established by Cardiovascular Magnetic Resonance
https://doi.org/10.21203/rs.3.rs-643159/v1
This work is licensed under a CC BY 4.0 License
published 27 Sep, 2021
Read the published version in The International Journal of Cardiovascular Imaging →
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not applicable, this is Letter to Editor
Funding: None
Conflicts of interest/Competing interests: No financial relationships
Availability of data and material: Authors have full control of all primary data and agree to allow the journal to review their data if requested.
Code availability: Not applicable
Authors' contributions Each author has contributed substantially to the research, preparation and production of the manuscript and approves its submission to The International Journal of Cardiovascular Imaging. Each author agrees to be accountable for all aspects of the work.
Ethics approval (include appropriate approvals or waivers): The study has ave been approved by the institutional ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Measurement of mitral and tricuspid annular plane systolic excursion (MAPSE, TAPSE) by echocardiography provides additional information for biventricular functional assessment with high reproducibility. To date, cardiovascular magnetic resonance (CMR) equivalents of MAPSE and TAPSE for paediatric patients are not available. This study aimed to provide a set methodology for the evaluation of longitudinal function and reference values in healthy paediatric patients.
The study population consisted of all children and adolescents retrospectively selected from who underwent a CMR scan between 2016-2020, resulting in normal cardiac findings. Images were obtained with 1.5T scanners (Sonata/Avanto, Siemens Medical Solutions, Germany) and were analysed by a single observer using CMR post-processing software (CMRTools; Cardiovascular Imaging Solutions, UK).
Lateral and septal MAPSEs (L-MAPSE, S-MAPSE) and TAPSE were measured from 4-chamber bSSFP cines. L-MAPSE and S-MAPSE were measured as the distance between the cutting edge of mitral annulus with left ventricular (LV) lateral wall or septum, respectively, captured at end-diastole and at end-systole. TAPSE was measured as the distance between the cutting edge of the tricuspid annulus with right ventricular (RV) free wall captured at end-diastole and at end-systole (Figure 1).
Intraobserver and interobserver variability was determined in 25 patients measured by two independent observers, using Intraclass correlation coefficient (ICC).
Fulfilling the inclusion criteria were 138 paediatric patients [88 males] with a mean age (SD) of 13.3 (2.9) years (range 4.0-17.0). The mean body surface area (BSA) was 1.6 (0.3) m2 [range 0.7-2.2].
Table 1 shows normal MAPSE and TAPSE values.
For L-/S-MAPSEs, simple linear regression showed a weak but significant correlation with age^2 (r=0.28,p=0.001/r=0.36,p=0.001), BSA (r=0.26,p=0.001/r=0.32,p=0.001) and LV end-diastolic volume index (r=0.24,p=0.003/r=0.22,p=0.009; LVEDVi). When tested in a multivariable model, only correlation with age^2 for both MAPSEs and with LVEDVi for L-MAPSE was maintained.
For TAPSE, simple linear regression showed a weak but significant correlation with age^2 (r=0.22,p=0.008), BSA (r=0.30,p=0.0001) and RV end-diastolic volume index (r=0.33,p=0.0001; RVEDVi). In a multivariable model, only correlation with RVEDVi was maintained.
The methods for measuring MAPSEs and TAPSE demonstrated excellent intraobserver agreement (L-MAPSE ICC=0.89,p<0.0001; S-MAPSE ICC=0.90,p<0.0001; TAPSE ICC=0.98,p<0.0001) and high interobserver agreement (L-MAPSE ICC=0.70,p<0.0001; S-MAPSE ICC=0.81,p<0.0001; TAPSE ICC=0.95,p<0.0001).
Ejection fraction (EF) is a widely recognised index of global systolic function in guidelines and clinical practice. However, EF alone has low sensitivity in detecting early contractile impairment with limitations in certain conditions[1]. It is widely considered that the more longitudinally oriented subendocardial fibres provide a significant contribution to normal cardiac function. Echocardiographic studies have established the correlation of MAPSE and TAPSE with LVEF and RVEF. Moreover, MAPSE and TAPSE have been shown to be more sensitive than EF in certain settings including heart failure with preserved LVEF. TAPSE shows high negative predictive power in detecting RV dysfunction and has been shown to be an independent predictor of cardiovascular death in the general population, especially in individuals with normal EF[5].
These data provide the imaging community with normal reference values of CMR-derived MAPSE and TAPSE in healthy paediatric cohorts to serve as additional parameters for the evaluation of LV and RV global function.
Table 1. Normal MAPSE, TAPSE values for our study population presented in age groups as mean (SD) and centiles.
|
|
Age group [yrs] |
n |
Mean (SD) [mm] |
Centiles |
Actual Value (Z-Score) |
|
|
|
|
|
|
|
|
L-MAPSE |
4-9 |
15 |
13.3 (1.3) |
2.5th; 97.5th |
10.8 (-2.5); 15.5 (+1.6) |
|
10-14 |
66 |
13.6 (1.2) |
2.5th; 97.5th |
10.0 (-3.2); 15.7 (+1.6) |
|
|
15-17 |
57 |
14.0 (1.0) |
2.5th; 97.5th |
11.9 (-1.6); 15.9 (+1.9) |
|
|
|
|
|
|
|
|
|
S-MAPSE |
4-9 |
15 |
11.7 (1.4) |
2.5th; 97.5th |
9.5 (-2.6); 13.8 (+0.7) |
|
10-14 |
66 |
12.8 (1.2) |
2.5th; 97.5th |
10.1 (-2.1); 14.9 (+1.6) |
|
|
15-17 |
57 |
13.2 (1.3) |
2.5th; 97.5th |
9.7 (-2.4); 15.8 (+2.1) |
|
|
|
|
|
|
|
|
|
TAPSE |
4-9 |
15 |
22.8 (3.8) |
2.5th; 97.5th |
18.2 (-1.9); 29.5 (+1.6) |
|
10-14 |
66 |
24.3 (2.8) |
2.5th; 97.5th |
18.6 (-1.8); 29.4 (+1.6) |
|
|
15-17 |
57 |
24.8 (3.4) |
2.5th; 97.5th |
18.6 (-1.8); 32.7 (+2.6) |
published 27 Sep, 2021
Read the published version in The International Journal of Cardiovascular Imaging →
Editorial decision: Minor revisions
06 Jul, 2021
Editor invited by journal
05 Jul, 2021
Reviews received at journal
23 Jun, 2021
Reviewers invited by journal
22 Jun, 2021
Editor assigned by journal
21 Jun, 2021
First submitted to journal
20 Jun, 2021
You are reading this latest preprint version