ORIGINAL INVESTIGATION Tricuspid Annular Plane Systolic Excursion Is Reduced in Infants with Pulmonary Hypertension Dala Zakaria, M.D.,* Ritu Sachdeva, M.D.,* Jeffrey M. Gossett, M.S.,† Xinyu Tang, Ph.D.,† and Matthew J. O’Connor, M.D.* *Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, Arkansas; and †Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas Background: Right ventricular (RV) function is reduced in infants with pulmonary hypertension (PH) but echocardiographic assessment can be challenging. We sought to determine the role of tricuspid annular plane systolic excursion (TAPSE) in infants with PH and compared it with other markers such as tricuspid annular S’ and RV fractional area change (RVFAC). Methods: Retrospective review of medical records of 30 infants treated for PH and 69 healthy controls from January 2012 to November 2012 was per- formed. Patients with significant congenital heart disease were excluded. Offline analysis of echocardio- grams was performed to obtain TAPSE, tricuspid annular S’, and RVFAC. TAPSE was indexed to body surface area (TAPSE/BSA). Logistic regression analysis was performed to evaluate the relation between echocardiographic markers and PH. Results: TAPSE and TAPSE/BSA were significantly lower in PH patients. PH patients were younger than controls; however, TAPSE was significantly lower in PH patients after matching with controls by age. Tricuspid annular S’ was decreased in PH patients, but RVFAC was similar. On multivariate analysis, tricuspid S’ did not have a significant effect on the probability of PH (P = 0.067). The odds of PH significantly increased with each 1 mm decrease in TAPSE (OR 1.78, 95% CI 1.26–2.45). Inter-observer agreement for TAPSE showed concordance correlation coefficient of 0.89. Conclusions: TAPSE is a feasible and reproducible marker of RV systolic function in infants with PH and is superior to tricuspid annular S’ and RVFAC. Longitudinal studies are needed to evaluate the role of TAPSE in serial evaluation of PH. (Echocardiography 2014;00:1–5) Key words: pulmonary hypertension, children, echocardiography, TAPSE Pulmonary hypertension (PH) is a common cause of morbidity and mortality in infants. Two common causes of PH in infants include persis- tent PH of the newborn (PPHN) and bronchopul- monary dysplasia in premature infants. 1,2 The incidence of PPHN is approximately 1 in 500 live births and has a mortality of up to 10%. 1 The clinical syndrome of PH in infants has multiple etiologies, such as vasoconstriction, pulmonary vascular hypoplasia, pulmonary venous obstruc- tion, and pulmonary parenchymal disease, all of which share an abnormal elevation of pulmonary vascular resistance. 1,3 Severe PH results in impaired oxygenation, right ventricular (RV) fail- ure, and pulmonary-to-systemic shunting, all of which result in cyanosis. Secondarily, severe PH causes low cardiac output due to decreased left heart preload on account of decreased pulmo- nary venous return and the mechanical effects of the hypertensive RV on left heart filling. Advances in neonatal intensive care, including high-fre- quency ventilation, surfactant instillation, extra- corporeal membrane oxygenation (ECMO), and inhaled nitric oxide (iNO), have reduced PPHN- related mortality. 4–6 PH is ideally evaluated by cardiac catheteriza- tion since pulmonary vascular resistance and right heart hemodynamics can be directly mea- sured. 7 However, it is an invasive technique with significant risks in patients with PH. Transthoracic echocardiography (TTE) is rou- tinely used for assessment of RV systolic pressure in neonates with PH. However, RV functional assessment in PH is typically qualitative in nature, which leads to inter-observer variability and limits the ability to follow RV function over time. Studies in adult patients with PH have used several markers to quantitate RV systolic function and have reported their prognostic relevance as well. These markers include tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), and Doppler tissue Address for correspondence and reprint requests: Dala Zaka- ria, M.D., University of Arkansas for Medical Sciences, Arkan- sas Children’s Hospital, Little Rock, AR. Fax: 501-364-3667; E-mail: dzakaria@uams.edu 1 © 2014, Wiley Periodicals, Inc. DOI: 10.1111/echo.12797 Echocardiography