*Z-Scores for RV systolic function.*

Using data published in the June 2009 JASE, this calculator determines the age-adjusted Tricuspid Annular Plane Systolic Excursion (TAPSE) z-scores:

#### Notes:

For the purpose of calculating the z-score, I used the published mean and "-3SD" lower limit to calculate each SD ([mean – lower limit] / 3)- which is a little bit *off-label*. That is, the standard deviation by itself is not published— only the ±2 and ±3 ranges are published— and there is some variation in how those back-calculate to "1 SD". Even though the title of the article suggest using the data for *calculating* z-scores, it is not perfectly clear how we are supposed to do this.

For the purpose of drawing the plot, I used the published ±2 SD values (the 2.5 – 97.5 percentiles).

While the authors note the independent influence of BSA on TAPSE (they also provide a separate graph for BSA vs. TAPSE), it is not clear to me how we are supposed to apply this information. For each age group, a TAPSE/BSA index value is determined by dividing the mean TAPSE by the mean BSA for each age group. The indexed values are noted to decrease with increasing age/BSA. However, no *range* of normal indexed values is given. The manner in which BSA was estimated for the study is not presented. The BSA vs. TAPSE data used to construct their graph are not published.

#### References:

Right ventricular function in infants, children and adolescents: reference values of the tricuspid annular plane systolic excursion (TAPSE) in 640 healthy patients and calculation of z score values.

Koestenberger M, Ravekes W, Everett AD, Stueger HP, Heinzl B, Gamillscheg A, Cvirn G, Boysen A, Fandl A, Nagel B.

J Am Soc Echocardiogr. 2009 Jun;22(6):715-9. Epub 2009 May 7.