TAPSE

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TAPSE measures the longitudinal displacement of the tricuspid annulus toward the RV apex during systole.

Tricuspid annular plane systolic excursion (TAPSE) is a measurement of

[A] LV Function
[B] RV Function
[C] Mitral Valve
[D] Tricuspid Valve

TAPSE is measured using

[A] M-mode echocardiography
[B] 2D echocardiography
[C] 3D echocardiography
[D] Color Doppler

[A] < 10
[B] >10
[C] <16
[D] >16

A normal value for tricuspid annular plane systolic excursion (TAPSE) is 15–25 mm. 

    • TAPSE is measured using M-mode echocardiography in the apical four-chamber view.
    • It’s a measurement of how far the lateral tricuspid annulus moves toward the apex during systole
    • TAPSE <17 mm indicates right ventricular systolic dysfunction.
    • TAPSE <14 mm indicates a poor prognosis in patients with chronic heart failure

TAPSE – Overview

  • Definition: TAPSE measures the longitudinal displacement of the tricuspid annulus toward the RV apex during systole.
  • Purpose: Simple echocardiographic index of right ventricular (RV) systolic function.
  • Technique:
    • Obtained in apical 4-chamber view with M-mode cursor through the lateral tricuspid annulus.
    • Measures the vertical excursion in millimeters.
  • Normal value: ≥ 17 mm (ASE guidelines).
  • Abnormal: < 17 mm indicates RV systolic dysfunction.
  • Advantages:
    • Quick, reproducible, angle-independent (within reason).
    • Useful in ICU, cardiology OPD, and follow-up.
  • Limitations:
    • Only assesses longitudinal function — may be normal in diseases affecting radial contraction or regional RV dysfunction.
    • Angle dependency if image acquisition is suboptimal.
  • Clinical uses:
    • Pulmonary hypertension monitoring.
    • Prognostication in heart failure.
    • Post-cardiac surgery RV function assessment.
    • Evaluation in congenital heart diseases.
1. What does TAPSE measure?
A. Longitudinal excursion of the tricuspid annulus toward the apex during systole
B. Radial thickening of the RV free wall
C. Mitral annular displacement
D. Left atrial volume change
TAPSE uses M-mode at the lateral tricuspid annulus in the apical 4-chamber view to measure longitudinal RV systolic function.
2. What is the commonly accepted normal TAPSE value (ASE)?
A. < 10 mm
B. ≥ 17 mm
C. ≥ 30 mm
D. Exactly 20 mm only
American Society of Echocardiography recommends TAPSE ≥ 17 mm as normal; lower values suggest RV systolic dysfunction.
3. Which view and mode are used to record TAPSE?
A. Parasternal long-axis, color Doppler
B. Subcostal view, tissue Doppler
C. Apical 4-chamber view with M-mode through the lateral tricuspid annulus
D. Apical 2-chamber with PW Doppler
M-mode cursor is placed through the lateral tricuspid annulus in the apical 4-chamber to measure displacement during systole.
4. A TAPSE of 12 mm suggests:
A. Normal RV function
B. Hyperdynamic RV
C. Isolated LV failure only
D. Reduced RV systolic function
Values < 17 mm generally indicate impaired RV systolic function; 12 mm is clearly reduced.
5. TAPSE primarily assesses which component of RV contraction?
A. Longitudinal (base-to-apex) shortening
B. Radial thickening
C. Circumferential shortening
D. Apex-to-base rotation
TAPSE captures the longitudinal motion of the tricuspid annulus — the main component of RV systolic shortening.
6. Which of the following is a limitation of TAPSE?
A. It measures radial function only
B. It assesses only longitudinal function and may miss regional or radial dysfunction
C. It requires invasive monitoring
D. It is unaffected by TR
TAPSE reflects longitudinal motion and can be normal despite other RV dysfunction patterns; it can also be influenced by severe TR.
7. Which alternative echo measure evaluates RV systolic function by area change?
A. TAPSE slope
B. Mitral annular S’
C. Fractional area change (FAC)
D. Ejection fraction of LA
FAC measures RV area change from diastole to systole in the apical 4-chamber, reflecting global RV systolic function.
8. Tissue Doppler S’ (tricuspid lateral annular systolic velocity) complements TAPSE because it:
A. Measures radial motion only
B. Is a valve gradient
C. Measures LA strain
D. Quantifies annular systolic velocity and offers angle-dependent velocity data
TDI S’ measures systolic velocity of the tricuspid annulus and complements TAPSE; both assess longitudinal RV performance.
9. Which TAPSE value would most likely predict adverse prognosis in pulmonary hypertension?
A. Very low TAPSE (e.g., < 10–12 mm)
B. TAPSE = 25 mm
C. TAPSE = 30 mm
D. TAPSE ≥ 20 mm
Markedly reduced TAPSE correlates with worse outcomes in pulmonary hypertension and RV failure.
10. Which is TRUE about TAPSE measurement reproducibility?
A. It requires 3D echo for accuracy
B. It is simple and reproducible but depends on angle and apical view quality
C. It is highly operator-independent
D. It cannot be repeated
TAPSE is easy and reproducible when image quality is good, but poor apical windows or off-axis M-mode can affect accuracy.
11. In acute right ventricular infarction, TAPSE is expected to:
A. Increase
B. Remain unchanged
C. Decrease
D. Measure LV output
RV infarction impairs longitudinal RV systolic function, resulting in reduced TAPSE.
12. Severe tricuspid regurgitation (TR) can affect TAPSE because:
A. It always increases annular motion
B. TAPSE is independent of TR
C. TR only affects LV metrics
D. TR can augment annular excursion and may overestimate true RV contractility
Severe TR causes volume loading of the RV and can increase annular motion even when contractility is reduced, misleading TAPSE interpretation.
13. TAPSE/PASP ratio is used to:
A. Estimate RV–PA coupling and prognostic stratification
B. Measure LV preload exclusively
C. Replace BNP measurement
D. Quantify left atrial pressure
The TAPSE/PASP ratio approximates RV–pulmonary arterial coupling; lower ratios indicate worse coupling and prognosis.
14. Which imaging modality provides a more global RV ejection fraction compared to TAPSE?
A. Chest X-ray
B. Cardiac MRI (RV ejection fraction)
C. PW Doppler of IVC
D. Coronary angiography
Cardiac MRI is the reference standard for RV volumes and global RVEF, whereas TAPSE is a simple longitudinal surrogate.
15. How should TAPSE be indexed in clinical interpretation?
A. Indexed to age only
B. Indexed to BMI only
C. Interpreted with other RV metrics (FAC, S’, RV strain) and clinical context
D. Used alone always
TAPSE should be combined with FAC, S’ and clinical data for robust RV function assessment; no single measure is sufficient.
16. In mechanical ventilation with high intrathoracic pressures, TAPSE may:
A. Be unaffected
B. Always overestimate function
C. Be replaced by EKG
D. Decrease due to altered RV preload and afterload
Positive pressure ventilation can reduce venous return and alter RV loading, often reducing TAPSE measurements.
17. Which of these is an easy bedside advantage of TAPSE?
A. Rapid, quick assessment of RV systolic function with minimal training
B. Requires advanced post-processing
C. Only measurable by MRI
D. Requires contrast
TAPSE is simple to acquire and interpret at the bedside, making it useful in critical care and ER settings.
18. Which TAPSE change suggests improvement in RV function after therapy?
A. Decrease from 20 to 12 mm
B. Increase from 12 to 18 mm
C. No change
D. Sudden disappearance
An increase toward or above the normal threshold (≥17 mm) indicates improvement in longitudinal RV systolic function.
19. Which special population may have age-related TAPSE variation?
A. Neonates only
B. Pregnant women only
C. Elderly—TAPSE may mildly decline with age
D. TAPSE is identical across all ages
TAPSE can decrease slightly with age; interpret in clinical context and consider complementary measures.
20. Which statement best summarizes TAPSE use?
A. TAPSE replaces cardiac MRI
B. TAPSE measures LV function
C. TAPSE is useful only in pediatrics
D. TAPSE is a rapid, useful longitudinal RV function index but should be interpreted with other RV measures and clinical context
TAPSE is a handy bedside index, but combine it with FAC, S’, strain, imaging and clinical data for full RV assessment.

TAPSE — Short Q & A (20)

#QuestionAnswer
1What does TAPSE measure?Longitudinal excursion of the tricuspid annulus toward the apex in systole.
2Normal TAPSE value≥ 17 mm (ASE guideline).
3Imaging mode for TAPSEApical 4-chamber M-mode through lateral tricuspid annulus.
4Low TAPSE indicatesReduced RV systolic function.
5Primary contraction component TAPSE assessesLongitudinal shortening.
6Main limitation of TAPSEOnly measures longitudinal function; may miss regional/radial dysfunction.
7Alternative RV measure (area)Fractional area change (FAC).
8Complementary annular velocity measureTissue Doppler S’ of lateral tricuspid annulus.
9TAPSE in pulmonary hypertensionVery low TAPSE predicts worse prognosis.
10Reproducibility noteSimple & reproducible but depends on image quality and angle.
11TAPSE in RV infarctionExpect decreased TAPSE.
12Effect of severe TR on TAPSEMay augment annular motion and overestimate contractility.
13What TAPSE/PASP indicatesEstimate of RV–PA coupling; lower ratio worse.
14Gold standard for RV EFCardiac MRI (RVEF).
15How to interpret TAPSE clinicallyUse with FAC, S’, strain and clinical context.
16Mechanical ventilation effectHigh intrathoracic pressures can decrease TAPSE.
17Bedside advantageRapid, quick RV systolic assessment with minimal training.
18Sign of improvementTAPSE increase toward ≥17 mm suggests recovery.
19Age influenceTAPSE may mildly decline with age; consider context.
20Best summaryUseful longitudinal RV index — combine with other metrics for full assessment.

TAPSE

Primary: TAPSE, tricuspid annular plane systolic excursion, RV systolic function, TAPSE normal value
Secondary: TAPSE measurement, TAPSE vs FAC, tissue Doppler S’ tricuspid, TAPSE pulmonary hypertension prognostic
Long-tail: TAPSE in RV infarction, how to measure TAPSE M-mode, TAPSE limitations and interpretation, TAPSE PASP ratio

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