Assessment of right ventricular function in patients with chronic pulmonary hypertension using tissue doppler imaging

Chronic pulmonary hypertension [CPHT] has a great impact on both right ventricular [RV] systolic and diastolic properties and the assessment of those properties is not always feasible by traditional echocardiography examination. Tissue Doppler imaging [TDI] has recently emerged as a new, rapid and noninvasive tool for evaluation of RV systolic function. To determine the right ventricular systolic and diastolic function in patients with chronic pulmonary hypertension by tissue Doppler imaging and its correlation to conventional echocardiography parameters. The study included 30 consecutive patients with symptoms of right-sided heart failure due to CPHT who were in sinus rhythm, together with 10 normal subjects as controls. Pulsed-wave tissue Doppler imaging was used to measure peak systolic tricuspid annular velocity [Sa] as an index of RV function, peak early [Ea] and late [Au] diastolic tricuspid annular velocities. Among the 30 patients, 18 were females [60%] and 12 were males [40%]. Their mean age was 47.0 +/- 7.5 years. Among the 10 control subjects, 5 were males [50%] and 5 were females [50%]. The mean Sa velocity of the patient group was lower than the control group [9.57 +/- 2.06 vs. 15.05 +/- 1.75 cm/s., p < 0.001] signifying impairment of RV systolic function. The mean Ea velocity and the Ea/Aa ratio of the patient group was lower than the control group [9.85 +/- 3.21 vs. 17.95 +/- 2.27 cm/s., p < 0.001 and 0.98 +/- 0.58 vs. 1,54 +/- 0.18, p < 0.05 respectively], while the mean Aa velocity did not show any significant difference between the two groups [11.94 +/- 5.25 vs. 11.67 +/- 1.31 cm/s., p = NS]. In the patient group, there was a very good inverse correlation between both right ventricular diastolic dimension, right ventricular systolic pressure and Sa velocity as an index of RV systolic function [r = - 0.79, p < 0.001, and r = - 0.57, p < 0.001, respectively]. There was a very good correlation between E/A ratio of the trans-tricuspid Doppler flow and Ea/Aa ratio measured by TDI of the tricuspid annular motion "indices of diastolic function" [r = 0.79, p <0.001]. TDI is a new noninvasive method to detect systolic and diastolic dysfunction in patients with chronic pulmonary hypertension

Assessment of right ventricular function before and after balloon pulmonary valvuloplasty using doppler tissue imaging

Although balloon pulmonary valvuloplasty [BPV] and its consequences were heavily studied, less information is available concerning its effects on right ventricular [RV] functions. Doppler tissue imaging [DTI] has recently emerged as a new, rapid and non-invasive tool for evaluation of RV systolic function. to investigate the immediate and medium-term consequences of BPV on systolic and diastolic right ventricular functions using Doppler tissue imaging. This study included 21 patients with isolated valvular pulmonary stenosis referred to Ain Shams University hospital for BPV and 22 age- and sex-matched healthy controls. Pulsed Doppler tissue imaging was used to measure peak systolic tricuspid annular velocity [Sa], peak early [Ea] and late [Aa] diastolic tricuspic annular velocities before, immediately after, and at 3-month after BPV. The Sa wave was lower in patients with pulmonary stenosis versus controls [10.02 +/- 2.16 vs. 12.90 +/- 1.17 cm/s, p = 0.0001], implying RV systolic dysfunction The Ea/Aa ratio was lower [and reversed] in the patient group versus controls [0.73 +/- 0.23 vs. 1.64 +/- 0.42 cm/s, p = 0.0001] denoting RV diastolic dysfunction. The post BPV hemodynamic effects included significant reduction in the peak pressure gradient [PPG] across stenotic pulmonary valve from 97.5 to 41.3 mmHg [p = 0.0001], and drop of RV systolic pressure [RVSP] from 119.7 to 60. 1 mmHg [p = 0.0001]. The Sa velocity showed a significant increase from 10.02 +/- 2.16 to 11.63 +/- 1.27 cm/s afte BPV [p = 0.0001], denoting improvement in systolic function. The improvement of RV function was highly correlated with the drop in RVSP, and this correlation was better if assessment of RV function was done with Sa wave [r = 0.78, p = 0.001] than with echo RVEF [r = 0.5, p = 0.08] in patients without significant tricuspid re gurgitation. At 3-month follow up, the RV diastolic dysfunction improved [87.5% immediately post BPV vs. 25% at follow up, p = 0.0001]. Balloon pulmonary valvuloplastv significantly relieves the pulmonary obstruction with immediate improvement of right ventricular systolic function, that is significantly correlated to reduction of right ventricular systolic pressure, and medium term improvement of right ventricular diastolic dysfunction