Right ventricular (RV) failure associated with pulmonary artery hypertension (PAH) in patients with chronic obstructive pulmonary disease (COPD) has important prognostic implications. The noninvasive evaluation of the RV failure in patients with COPD still represents a problem. The purpose of this study was to evaluate RV failure in patients with COPD using pulsed wave Doppler tissue imaging (DTI).
46 males with COPD (mean age 57±8 years; mean FEV1 30±8%) were studied. All patients underwent clinical and laboratory examinations. RV wall thickness, RV end-diastolic diameter, RV systolic and diastolic functions were evaluated with two-dimensional echocardiography. The tricuspid inflow profile (E, A, E/A, DT) and hepatic vein flow velocity (S, D, A) were measured with pulsed Doppler. Peak velocities of the tricuspid annular motion (Sa, Ea, Aa, Ea/Aa) were derived from pulsed DTI.
RV systolic dysfunction (RV ejection fraction < 45% and Sa < 11.5 sm/s) was detected in 13% of cases. RV diastolic dysfunction was detected in 100% of cases. Impaired relaxation pattern of tricuspid inflow (E/A<1.0 and Ea/Aa<1.0) was detected in 69.6%, pseudonormal pattern - in 17.4% (2.0<E/A>1.0 and Ea/Aa<1.0), restrictive pattern - in 13% (E/A>2.0). There were significant correlations between tricuspid annular motion (Ea/Aa) and tricuspid inflow profile (E/A) (r=-0.56; p=0.019), RV wall thickness (r=0.72; p=0.001), RV end-diastolic diameter (r=0.70; p=0.001) and RV ejection fraction (r=0.70; p=0.001); between systolic pulmonary artery pressure and hepatic vein flow velocity (retrograde A velocity) (r=0.60; p=0.007).
Our study confirmed high prevalence of RV systolic and diastolic dysfunction in patients with COPD. Physicians should detect RV failure in patients with COPD.
The complex echocardiography evaluation with DTI provides a simple, rapid and noninvasive tool for diagnosis of RV failure in patients with COPD.
Vasiliy Pyankov, None.