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J Korean Soc Emerg Med > Volume 33(5); 2022 > Article
Journal of The Korean Society of Emergency Medicine 2022;33(5): 487-496.
응급 현장 초음파에서 측정된 승모판륜 수축 이동과 삼첨판륜 수축 이동의 유용성: 응급실에서 임상적으로 적용하기 위한 비대면 선행 실험연구
조재열, 황정성, 홍정석
울산대학교병원 응급의학과
Usability consideration about mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) with point of care ultrasound (POCUS) in emergency: untact pilot experiment before clinically applying them in emergency room
Jae Youl Cho, Jung Sung Hwang, Jung Seok Hong
Department of Emergency Medicine, Regional Emergency Center, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
Correspondence  Jung Seok Hong ,Tel: 052-250-7112, Fax: 052-250-8150, Email: skdosada@uuh.ulsan.kr,
Received: September 29, 2021; Revised: November 8, 2021   Accepted: November 11, 2021.  Published online: October 31, 2022.
As a part of point-of-care ultrasound (POCUS), the rapid assessment of cardiac systolic function using tricuspid annular plane systolic excursion (TAPSE) and mitral annular plane systolic excursion (MAPSE) are thought to be valuable tools during a cardiac emergency. This article is an untact pilot experiment before the clinical application of these procedures in an emergency room.
Totally, 206 video samples from YouTube concerning echocardiograms of a normal heart, ischemic heart disease, congestive heart failure, cardiomyopathy, pulmonary hypertension, and pulmonary embolism were extracted and analyzed with free programs opened in internet services.
The values of MAPSE, TAPSE, and TAPSE+MAPSE ranged between 13.3±2.3 mm, 23±2.8 mm, and 36±4.5 mm, respectively, in the normal echocardiogram versus 7.8±2.5 mm, 16.5±5.0 mm, and 24.2±6.4 mm, respectively, in an abnormal echocardiogram (P<0.05). Positive correlations were obtained between MAPSE and TAPSE, MAPSE and TAPSE+MAPSE, and TAPSE and TAPSE+MAPSE (R2=0.346, R2=0.687, and R2=0.871, respectively). MAPSE ≤ 7.7 mm, TAPSE ≤18.5 mm, and TAPSE+MAPSE ≤27.7 mm show 100% sensitivity, and the specificities for an abnormal echocardiogram at these values are 51.8%, 63.3%, and 71.7%, respectively. At TAPSE ≤18.5 mm and TAPSE/(TAPSE+MAPSE) ≤0.61, the sensitivity of pulmonary hypertension containing a pulmonary embolism is 81.2%, and the specificity is 81%. It is presumed that the lower these values, the higher the emergency.
In a cardiac emergency, differentiating left or right systolic heart failure is probably useful by checking not only MAPSE or TAPSE using POCUS, but also determining the ratios MAPSE/(MAPSE+TAPSE) or TAPSE/(MAPSE+TAPSE). However, further retrospective or prospective studies in an emergency room are required for a specific disease diagnosis.
Key words: Point of care ultrasound; Mitral annular plane systolic excursion; Tricuspid annular plane systolic excursion; Pulmonary hypertension; Pulmonary embolism
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