SESSION TITLE: PAH and the Heart
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 28, 2015 at 08:45 AM - 10:00 AM
PURPOSE: The value of right ventricular (RV) tissue doppler (TD) diastolic patterns in pulmonary hypertension (PHTN) is unclear and not been studied and formed the basis of our study.
METHODS: Retrospective transthoracic echocardiogram (TTE) of 57 patients who had Type I and II PHTN confirmed on right heart catheterization (RHC) was performed. (Type I =33, Type II= 24, mild- moderate PASP = 31, severe PASP= 26). 22 consecutive patients without cardiopulmonary disease served as control. Absolute values of RV e', RV a', RV e'/a' ratio, RV doppler tei index and RV tissue tei index were compared and correlation coefficients were obtained with pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) on RHC. Chi-square tests and two-group independent t-tests were used for statistical analysis.
RESULTS: Both study groups comprised primarily of females. 54% of test group patients had mild to moderate (40-60 mm Hg) and 46 % had severe (>60 mm Hg) PHTN. RV TAPSE, RV S' , RV e’ and RV a’ values were all significantly decreased in PHTN group ( all p=<0.05 vs controls) with no significant difference in RV e’/a’ ratio (1.1 cms/sec). Doppler (0.6 vs 0.4, p<0.05) and tissue (1 vs 0.5, p<0.05) Tei index were significantly higher in PHTN group. Significant negative correlation was observed between RV a' velocity and PVR. (p<0.05). Significant correlation of RHC PASP was observed with RV a’ velocity, most significant with mild to moderate PHTN (p<0.05) and in patients with Type II PHTN (p<0.05). Tissue Tei index was significantly higher in patients with PHTN on RHC, most significant with severe PHTN (p<0.05) and in Type I PHTN (p<0.05).
CONCLUSIONS: RV S, RV e’ and RV a’ values were significantly decreased while doppler and tissue tei index values were significantly higher in patients with PHTN. Significant correlation of RV a’ velocity with both PASP and PVR on RHC was observed. Lower values of RV a' velocity correlated with mild to moderate PHTN and PHTN II. Higher values of tissue tei index correlated with severe pulmonary pressures and PHTN I on RHC.
CLINICAL IMPLICATIONS: This is the first analysis of correlation between RV diastolic parameters with gold standard measures of PHTN. Our study suggests that incorporating RV tissue Doppler parameters and Tei index in TTE evaluation of PHTN adds value. While significantly decreased values of RV a’ velocity point towards mild to moderate PHTN and PHTN II, increased tissue tei index may point towards severe PHTN and PHTN I.
DISCLOSURE: The following authors have nothing to disclose: Nishtha Sareen, Alexandra Mariychina, Meredith Mahan, Hector Cajigas, Karthik Ananthasubramaniam
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