Measuring TAPSE — Step-by-Step Guide (ASE 2025 Update)

What is TAPSE?

TAPSE (Tricuspid Annular Plane Systolic Excursion) measures the longitudinal displacement of the tricuspid annulus toward the apex during systole. It serves as a robust, reproducible, and clinically essential marker for right ventricular (RV) longitudinal systolic function.

How to measure TAPSE?

1. Achieving the RV-Focused Apical 4-Chamber View

According to the latest ASE 2025 guidelines, measurements of the right ventricle must not be performed in a standard apical 4-chamber (A4C) view. A standard view often leads to "foreshortening" (underestimation of the actual size and function). Instead, an RV-focused view is mandatory.

How to obtain the RV-focused view:

• Start with a standard A4C view optimized for the left ventricle.

• Reposition: Slide the transducer slightly more laterally along the chest wall (towards the mid-axillary line).

• Angle: Tilt the transducer medially to bring the right ventricle into the center of the imaging sector.

• Validation: The view is correct when the RV basal diameter is maximized and the true RV apex is clearly visible. The left ventricle should still be visible but is no longer the central focus.

2. Positioning the M-Mode Cursor

Once the optimal RV-focused view is established:

• Activate M-Mode.

• Place the cursor through the lateral tricuspid valve annulus.

• Alignment: It is absolutely critical that the cursor is aligned strictly parallel to the longitudinal motion of the RV free wall (from base to apex). Any angular deviation will lead to a "cosine error" and underestimate the true excursion.

3. Performing the Measurement

Measure the maximal vertical displacement from the lowest point of the annular motion (end-diastole) to the highest point of the excursion (peak systole).

Normal Values and Interpretation (ASE 2025)

The ASE 2025 guidelines have refined the classification of RV dysfunction. A value of > 17 mm is considered normal regardless of gender.

Important Addition: TAPSE/PASP Ratio To assess RV-pulmonary arterial (RV-PA) coupling, the TAPSE/PASP ratio is increasingly important:

• Normal value: Typically > 0.36 mm/mmHg (often 0.5–0.7 in healthy individuals).

• Values < 0.36 mm/mmHg indicate RV-PA uncoupling, meaning the RV is no longer able to compensate for the pulmonary afterload.

Common Pitfalls and How to Avoid Them

Pitfall 1: Incorrect Cursor Placement

Error: The cursor is placed too far medially (on the septum) or too far laterally (on the RV wall). Solution: Use the 2D image to precisely identify the insertion of the tricuspid ring at the lateral wall before activating M-mode.

Pitfall 2: Transducer Angulation (Standard View)

Error: Using a standard A4C view where the RV appears too small. Consequence: The direction of motion is not parallel to the M-mode beam, leading to false-low values. Solution: Optimize the imaging plane to the RV-focused view until the RV is displayed at its maximum width.

Pitfall 3: Arrhythmias (e.g., Atrial Fibrillation)

Error: Measuring only a single heart cycle. Consequence: High variability due to varying RR intervals. Solution: In patients with atrial fibrillation, measure and average at least 5 to 10 consecutive cycles.

Pitfall 4: Relying on TAPSE as a Standalone Parameter

Limitations: TAPSE only reflects longitudinal function and is angle-dependent. It can be falsely low after cardiac surgery (pericardiotomy) despite normal global function. Solution: Always combine TAPSE with other parameters like RV-FAC(Fractional Area Change), TDI s', or 3D-RVEF.

Calculate TAPSE Directly

On echokardio.de, you can instantly interpret TAPSE values against the ASE 2025 reference ranges:

→ Open TAPSE Calculator

The calculator automatically classifies the function and optionally calculates the TAPSE/PASP ratio if the pulmonary pressure is known.

Summary for Clinical Practice

1. Optimize to RV-focused view (Maximize RV size, avoid foreshortening).

2. Align M-Mode cursor strictly parallel to the lateral annulus motion.

3. Measure excursion from the lowest to the highest point.

4. Threshold: ≥ 17 mm is normal.

5. Multi-parametric approach: Always use TAPSE in conjunction with other RV markers.

6. Averaging: Average ≥ 5 cycles in cases of arrhythmia.