The utility of Right Ventricular (RV) Tissue Doppler Imaging (TDI) in Pulmonary Hypertension (PH) is poorly understood. The objective of this study was to correlate TDI of the RV with pulmonary hemodynamics in PH patients undergoing right heart catheterization (RHC).
In 20 patients with PH (WHO criteria), echocardiography was performed immediately before RHC. 10 healthy subjects served as controls. Patients with left ventricular systolic dysfunction, atrial fibrillation, prosthetic valve and coronary artery disease were excluded. Transvalvular pulse doppler measurements and annular TDI were performed on the tricuspid valve and directly correlated with RHC indices and the Brain Natriuretic Peptide (BNP) level.
On routine doppler, subjects with PH had a significantly higher tricuspid inflow E velocity (TE) (80.4 ± 14.9 vs. 61.9 ± 9.9 cm/s, p=0.05) and A velocity (75.7 ± 28.5 vs. 42.5 ± 8.1 cm/s, p<0.0001). On TDI, Tricuspid annular E’ (TE’) velocity was significantly reduced (9.9 ± 2.1 vs. 14.4 ± 3.3, p<0.001) in PH and so was TE’/A’ ratio, while Tricuspid A’ velocity remained unaffected. There was a significant but rather less robust relationship between tricuspid annular plane systolic excursion (TAPSE) and cardiac index (r=0.53, p= 0.023). TE velocity correlated with rising right atrial pressure (RAP) (r=0.52, p=0.033). Tricuspid annular E’ (TE’) velocity had an inverse relationship with pulmonary vascular resistance and RA pressure (p=0.36 for both). T E/E’ ratio had a stronger linear correlation with RAP (r=0.78, p=<0.001), right ventricular end diastolic pressure (RVEDP) (r=0.91, p <0.0001) and BNP (r=0.67, p=0.04). T E/E’ ratio of >8 predicted RAP of >10 mmHg, while T E/E’ ratio of >12 cm/s predicted an RVEDP of >15 mmHg and BNP of 200 pg/ml.
RVTDI is an effective non-invasive tool to assess RV diastolic dysfunction in patients with PH. RV diastolic dysfunction detected by TDI in patients with PH correlates significantly with RAP, RVEDP and BNP.
RV diastolic dysfunction has a poor prognostic implication in PH. Routine RVTDI can provide an early and reliable determination.
Usman Javed, No Financial Disclosure Information; No Product/Research Disclosure Information