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We don't tend to grade TAPSE, if that was your question.

Oh, so the then the general cut off value considered for reduced RV function< 16 or <18 or variable depending on the overall heart size? Also is there an instance when TAPSE is measured in normal range while there's clearly a RV Systolic dysfunction?

Yes, absolutely. For example, when there is severe TR, TAPSE may be high due to volume loading and in this instance misleading. It is a very load dependent measure, probably why it has been dropped from the recent PH guidelines.

Here's a question. Why is it that Pulmonary stenosis, a pressure loading condition, causes RV hypertrophy, but with pulmonary embolism which is also a pressure loading condition the RV does not hypertrophy but dilates instead?

Here's an answer: From what I understand, this is because pulmonary embolism is an acute pressure increase, and ventricle does not have time to hypertrophy. Hence, eccentric hypertrophy. But I could be wrong.

HiThanks for the comment. Sorry for the delay in getting back.We prefer to measure from the beginning of flow. Interestingly the paper the guidelines refer to actually states:"Acceleration time(ms) was measured from the onset of ejection to the time of peak flow velocity. Preejection period (ms) was measured from the onset of Q wave on a simultaneously recorded lead II ECG to the upstroke of the Doppler flow velocity deflection during systolic ejection."It may make a significant difference if the patient is in BBB.

+drgadham Thanks!!

+Helen barber Thanks for the feedback Helen.

+Soumya Ray Sorry - I didn't pick up your message. I have tried the link now www.ph-echocardiography-protocol.com and it seems to work fine. It is > 200MB and comes as a .zip file which you then need to extract. Let me know if any further problems. NB: I will be updating the guideline soon to reflect recent ESC/ERS recommendations.