Miscellaneous
Tissue Doppler Imaging Evaluation of Cardiac Adaptation to Severe Pulmonary Hypertension

https://doi.org/10.1016/j.amjcard.2007.06.047Get rights and content

Tissue Doppler imaging (TDI) was used to obtain additional insight into the cardiac adaptation to severe pulmonary arterial hypertension. Pulmonary hemodynamics and right and left ventricular function were investigated in 18 untreated patients, 12 with pulmonary arterial hypertension and 6 with chronic thromboembolic pulmonary hypertension. Fourteen age-matched healthy subjects served as controls for TDI measurements. Pulsed TDI was determined using atrioventricular planes and strain and strain rate along the right ventricular free wall, ventricular septum, and left ventricular lateral wall from 4-chamber apical views. Patients had early diastolic dysfunction, with decreased E-wave peak velocity and increased isovolumic relaxation time, both more important in the right than left ventricle. Compared with controls, strain and strain rate decreased along the right ventricular free wall with a midapical predominance (midbasal strain rate 1.7 ± 0.6 vs 2.2 ± 0.5; p = 0.02; midapical strain rate 0.9 ± 0.9 vs 2.3 ± 0.7; p <0.001), but were preserved along the left ventricular lateral wall. Tricuspid E-wave and isovolumic relaxation time (R = 0.62, p = 0.006), as well as midapical (r = 0.65, p = 0.004), but not midbasal, right ventricular strain and strain rate correlated with mean pulmonary artery pressures. In conclusion, cardiac function was abnormal in patients with severe pulmonary hypertension because of a combination of alterations in both diastolic and systolic right ventricular function and left ventricular diastolic function. Only right ventricular dysfunction correlated with pulmonary artery pressures.

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Methods

Eighteen patients, 12 with idiopathic pulmonary arterial hypertension and 6 with chronic thromboembolic pulmonary hypertension (5 men, 13 women; mean age 57 ± 15 years; body surface area 1.8 ± 0.2 m2), and 14 healthy controls (2 men, 12 women; age 52 ± 11 years; body surface area 1.7 ± 0.3 m2) gave informed consent to the study, which was approved by the institutional review board. Patients had been referred for diagnostic evaluation before starting prostacyclin or endothelin receptor blocker

Results

Two patients were in NYHA functional class II, 12 were in NYHA class III, and 4 were in NYHA class IV. Six-minute walk distances were 399 ± 136 m with a Borg scale of 6 ± 2 in patients and 636 ± 99 m with a Borg scale of 2 ± 1 in controls (p <0.001). In patients, arterial oxygen saturation was low-normal (92.9 ± 5.1%), and invasive hemodynamic assessment showed high mean pulmonary artery pressure (49 ± 13 mm Hg) and pulmonary vascular resistance (19 ± 9 WU.m2), low cardiac output Q (2.3 ± 0.7

Discussion

The present results showed that cardiac function was abnormal in patients with severe pulmonary hypertension because of alterations in both diastolic and systolic function of the right ventricle and diastolic function of the left ventricle. However, only right ventricular function alterations correlated with pulmonary artery pressures.

Conventional Doppler echocardiography repeatedly showed that patients with severe pulmonary hypertension presented with mitral inflow patterns characterized by

Acknowledgment

We thank Marie-Therese Gautier, MT, and the nurses of the Coronary Care Unit of the Department of Cardiology, Erasme University Hospital for collaboration.

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  • Cited by (0)

    The study was supported by Grant No. 3.4515.05 from the Fonds de la Recherche Scientifique Médicale and the Foundation for Cardiac Surgery, Belgium. Dr. Huez is a fellow of the “Fonds National de la Recherche Scientifique,” Belgium.

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