TAPSE is how far the lateral tricuspid annulus moves toward the apex during systole, measured in mm on M-mode. It is quick, reproducible and one of the standard measures of RV systolic function.
By James Napolitano. Cutoffs from the guidelines cited below.
Get the view
Start in the apical 4-chamber view, then slide slightly lateral and adjust until the RV free wall and the lateral tricuspid annulus are fully in view.
The annulus is the bottom left corner of the RV on the screen, where the free wall meets the tricuspid valve.
Live exampleFigure 1. Live RV-focused apical 4-chamber view. The M-mode cursor moves from the septum to the RV free wall, then onto the lateral tricuspid annulus. M-mode records every depth along the line, so watch which structures appear in the trace. Drag the cursor to aim it yourself.
Place the M-mode cursor
Run the cursor through the lateral tricuspid annulus, parallel to its motion toward the apex. M-mode is angle dependent: the more the cursor crosses the motion at an angle, the more TAPSE underestimates.
Through the RV free wall above the annulus the motion is smaller.
Through the septum you record septal motion, which is not TAPSE.
Measure
Lower the gain so the annulus is one clean bright line. Freeze and place calipers at the lowest point of the line (end-diastole, at the QRS) and at its peak (end-systole) in the same beat. The distance between them is TAPSE.
Live exampleFigure 2. Live TAPSE M-mode. Tap the lowest point of the annulus line, then the peak of the same beat.
Tap a trace to freeze and measure.
Stroke volume
Apical 5-chamber
Angle to flow --
What the gate records
Move the gate and watch the trace change.
Normal values
TAPSE above 17 mm is normal. 17 mm or less indicates RV systolic dysfunction.1,2
Pitfalls
TAPSE measures longitudinal function of the base only. It can look normal when other parts of the RV are not.
It is angle and load dependent.
Motion of the whole heart (translation) can distort it. Use a steady image.
TAPSE commonly falls after cardiac surgery even when overall RV function is preserved.
Practice this on live Doppler.Critical Care Echo Trainer has all five measurements: stroke volume, RVSP, diastolic function, tamponade and TAPSE. Random cases with an answer key, and the full Acquire view with probe position and technique for each. $59, one-time.
Mukherjee M, Rudski LG, Addetia K, et al. Guidelines for the echocardiographic assessment of the right heart in adults and special considerations in pulmonary hypertension: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2025;38(3):141-186.
Lang RM, et al. Recommendations for cardiac chamber quantification by echocardiography in adults. J Am Soc Echocardiogr. 2015;28:1-39.
Rudski LG, et al. Guidelines for the echocardiographic assessment of the right heart in adults. J Am Soc Echocardiogr. 2010;23(7):685-713.