TAPSE

TAPSE: Tricuspid annular plane systolic excursion — simple M-mode measurement of RV systolic function.

RV Assessment

TAPSE Measurement (mm)

M-mode measurement of lateral tricuspid annulus displacement from diastole to systole

Normal Reference Values

>16 mm: Normal

14–16 mm: Mild Dysfunction

11–14 mm: Moderate Dysfunction

<11 mm: Severe Dysfunction

Guidelines & Evidence

Clinical Details

Section 1

When to Use

First-line RV systolic function assessment on echocardiography

Screening for RV dysfunction in pulmonary hypertension

Risk stratification post-MI (especially inferior/RV infarction)

Serial monitoring in HF, PH, and after lung transplant

Prognostic indicator in acute decompensated HF

Key Advantages

Simple M-mode measurement; reproducible and operator-independent

No contrast required; works in poor acoustic windows

Correlates with RV EF from cardiac MRI

ESC/ASE endorsed; part of routine echo protocols

Section 2

Formula & Logic

Measurement Technique

Obtained in apical 4-chamber view (M-mode)

Cursor placed at lateral tricuspid annulus (not at RV free wall)

Measure systolic displacement from annular position in diastole to systole

Measured in mm; independent of image angle

Normal & Abnormal Values

TAPSE (mm)	RV Systolic Function	Prognosis
>16	Normal	Normal RV function
14–16	Mild Dysfunction	Mildly reduced
11–14	Moderate Dysfunction	Moderately reduced
<11	Severe Dysfunction	Severe reduction; high mortality risk

Section 3

Pearls/Pitfalls

Technical Notes

Must be lateral annulus (not at septum); septum shows reduced excursion by design

Reported as single value; not averaged across cardiac cycles

Angle-independent; true linear excursion measurement

Reduced TAPSE in LV dysfunction does not signify primary RV dysfunction

Prognostic Value

TAPSE <16 mm associated with HF readmission and mortality

Independent predictor of mortality in acute MI and HF

<11 mm indicative of severe RV dysfunction; consider mechanical support evaluation

Serial TAPSE decline (>2 mm/year) suggests disease progression

Section 4

Next Steps

Normal TAPSE (>16 mm)

Normal RV systolic function; standard monitoring

No RV-specific interventions required

Reassess if clinical deterioration or new symptoms

Mild–Moderate Dysfunction (11–16 mm)

Assess for cause: PH, HF, RV infarction, PE, primary RV disease

Serial echo monitoring every 6–12 months

Optimize HF therapy; consider diuretics if volume overloaded

Screen for PH with BNP/NT-proBNP and right heart catheter if indicated

Severe Dysfunction (<11 mm)

Urgent cardiology referral; assess for acute decompensation

Consider inotropic support if cardiogenic shock

Evaluate for MCS / transplant candidacy if advanced HF

Aggressive PH-directed therapy if pulmonary hypertension present

Complementary Calculators

Biplane Simpson EF

AVA (Continuity Equation)

MVA (Pressure Half-Time)

EROA (PISA Method)

RVSP Calculator

Section 5

Evidence Appraisal

Key Studies

Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography.

Rudski LG et al. • J Am Soc Echocardiogr.. 2010;e1-e42. The primary ASE guideline for RV assessment.

Section 6

Literature

Development

TAPSE measurement has been used in echocardiography since the early 2000s, emerging from systolic RV functional assessment studies. Standardized by ASE and ESC guidelines; now considered part of fundamental RV assessment on every echocardiogram.

Last Comprehensive Review: 2026

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