CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 4, July/August 2010
Cardiovascular Topics
186
AFRICA
Assessment of right ventricular systolic function using
tricuspid annular-plane systolic excursion in Nigerians
with systemic hypertension
KM KARAYE, AG HABIB, S MOHAMMED, M RABIU, MN SHEHU
Summary
Aim:
Right ventricular (RV) systolic function in patients with
hypertensive heart disease (HHD) is not well characterised.
The primary aim of this study was to assess the systolic func-
tion of the right ventricle in patients with HHD using tricus-
pid annular-plane systolic excursion (TAPSE).
Methods:
The study was cross-sectional in design and carried
out in Kano, Nigeria. Patients were recruited if they had
HHD on echocardiography and were at least 15 years of age.
Patients with other cardiac pathologies such as ischaemic
and valvular heart diseases were excluded. Patients were
considered to have abnormal RV systolic function if they had
reduced values of TAPSE (
<
15 mm). A
p
-value of
<
0.05 was
considered statistically significant.
Results:
A total of 186 patients were serially recruited over
seven months. Of these, 131 (70.4%) had normal RV systolic
function (group 1) and 55 patients (29.6%) had abnormal
function (group 2). Group 2 patients were older (
p
=
0.002)
and had a higher prevalence of peripheral oedema (
p
=
0.002),
moderate to severe dyspnoea, higher heart rate and lower left
ventricular ejection fraction (
p
<
0.001). Atrial arrhythmias
were also more prevalent among group 2 patients (
p
<
0.05).
The best correlate to TAPSE was the septal mitral annular-
plane systolic excursion (
r
=
+
0.541,
p
<
0.001). Several vari-
ables such as age predicted the presence of reduced TAPSE.
Conclusion:
The study found that almost one-third of patients
with HHD in Kano had RV systolic dysfunction as defined by
reduced TAPSE, and these patients had a greater prevalence
of factors associated with morbidity and mortality.
Keywords:
right ventricular systolic function, hypertension,
TAPSE
Submitted 25/12/09, accepted 10/3/10
Cardiovasc J Afr
2010;
21
: 186–190
DOI: CVJ-21.011
The right ventricle has a complex three-dimensional structure
with a crescent-shaped cavity when viewed in cross section. It
consists of three parts: the inflow tract, the apical ‘trabecular’
portion (which is basically immobile) and the outflow tract.
1
The
inflow and outflow portions contract perpendicularly to each
other: the proximal part longitudinally and the distal part circum-
ferentially, in the orientation of their respective muscle fibres.
1
Although the right ventricle can now be imaged and studied in
several ways, two-dimensional (2D) guided M-mode echocardi-
ography is an attractive tool due to its simplicity. Right ventricu-
lar (RV) long-axis movement represented by tricuspid annular-
plane systolic excursion (TAPSE) is an index that correlates
excellently with RV ejection fraction obtained with radionuclide
angiography and is independent of any geometric assumption.
2
TAPSE provides a simple method for global RV functional
assessment and is a strong predictor of prognosis in heart failure.
3
For many years the right ventricle was grossly underval-
ued and considered to function mainly as a conduit, while
its contractile performance was considered haemodynamically
unimportant. Since the early 1950s, however, the relevance of the
chamber in the maintenance of normal cardiac physiology was
recognised in several cardiovascular disorders.
4
Studies on RV
function among patients with hypertensive heart disease (HHD)
are rather few and have focused mainly on the diastolic function
of the chamber.
5,6
The primary aim of this study was to assess
the systolic function of the right ventricle in patients with HHD,
using TAPSE. A secondary aim was to compare the characteris-
tics of patients found to have normal RV systolic function with
those with abnormal function, as well as determine the correlates
of TAPSE among the patients.
Methods
The study was carried out in three echocardiography laboratories
within the city of Kano in Nigeria:Aminu KanoTeaching Hospital
(AKTH), Murtala Muhammad Specialist Hospital (MMSH)
and a private centre (PC). Kano is a state in the north-western
geopolitical zone of Nigeria and was previously reported to have
the highest prevalence of systemic hypertension in the country.
7
The research ethics committees of the study centres reviewed
and approved the study protocol. All recruited patients gave
informed written consent to participate in the study. The study
conformed to the principles outlined in the Declaration of
Department of Medicine, Bayero University, Kano, Nigeria
KM KARAYE, FWACP,
AG HABIB, FWACP
Department of Medicine, Aminu Kano Teaching Hospital,
Kano, Nigeria
KM KARAYE, FWACP,
AG HABIB, FWACP
S MOHAMMED, MWACP
M RABIU, MB BS
MN SHEHU, MWACP
