ABSTRACT
AIM: To study structural and functional changes of the right ventricle (RV) in patients with pulmonary hypertension (PH) of various etiologies and to assess an association of these changes with the levels of natriuretic peptides (NP). SUBJECTS AND METHODS: The study enrolled 102 patients with PH (29 with idiopathic PH (IPH), 15 with PH in the presence of chronic pulmonary thromboembolism (PTE), 18 with HP associated with scleroderma systematica (SS), 13 with PH in the presence of chronic obstructive pulmonary disease (COPD), 15 with PH associated with congenital heart disease, 12 with residual PH and a control group of 21 healthy volunteers. Conventional echocardiography (EchoCG) and tissue myocardial Doppler (TMD) EchoCG were performed. The plasma levels of brain NP (BNP) and atrial NP were measured. RESULTS: Conventional EchoCG revealed the most significant remodeling of the heart and pulmonary artery in patients IPH and the least one in those with COPD. TMD findings suggest that RV diastolic function was most and less significantly impaired in patients with IPH and in those with COPD, respectively, and corresponded to the level of NT-proBNP in patients with PH. In patients with PTE with SS, RV diastolic dysfunction (DD) dominated over systolic ones, the functional class and the level of NT-proBNP being comparable with those in patients with ILH. TMD could reveal RV DD in a larger proportion of patients with PH (in all groups) than could Doppler EchoCG. The ratio of the maximum RV early filling velocity to RV tricuspid valve (TV) ring peak movement rate in early diastole (TV E/EM) corresponded to the levels of NP and the magnitude of cardiac remodeling in patients with PH. ROC analysis revealed the intrinsic separating values of TV E/Em from the mitral ring (MR E/Em) which allowed the patients with higher NT-proBNP levels to be identified with a high sensitivity and a high specificity. An aggregate of factors, such as age, right atrial volume, and PA systolic pressure as shown by conventional EchCG and TMD readings, identified patients with PH and elevated NT-proBNP with 73.3% sensitivity and 90.7% specificity. CONCLUSION: TMD has advantages over conventional EchoCG in the detection of RV DD associated with elevated NP levels in patients with PH.
