MiscellaneousTissue Doppler Imaging Evaluation of Cardiac Adaptation to Severe Pulmonary Hypertension
Section snippets
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.
References (30)
- et al.
Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures
J Am Coll Cardiol
(1997) - et al.
Doppler echocardiographic index for assessment of global right ventricular function
J Am Soc Echocardiogr
(1996) - et al.
Effects of the oral endothelin-receptor antagonist bosentan on echocardiographic and Doppler measures in patients with pulmonary arterial hypertension
J Am Coll Cardiol
(2003) - et al.
Prognostic usefulness of tricuspid annular planes systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy
Am J Cardiol
(2000) - et al.
Doppler echocardiographic assessment of impaired left ventricular filling in patients with right ventricular overload due to primary pulmonary hypertension
J Am Coll Cardiol
(1986) - et al.
Correlation of left ventricular diastolic filling characteristics with right ventricular overload and pulmonary artery pressure in chronic thromboembolic pulmonary hypertension
J Am Coll Cardiol
(2002) - et al.
Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension
J Am Coll Cardiol
(2002) - et al.
Right ventricular function assessed by two-dimensional strain and tissue Doppler echocardiography in patients with pulmonary arterial hypertension and effect of vasodilator therapy
Am J Cardiol
(2006) - et al.
Recovery of regional right ventricular function after thrombolysis for pulmonary embolism
Am J Cardiol
(1999) - et al.
Differential changes in regional right ventricular function before and after a bilateral lung transplantation: an ultrasonic strain and strain rate study
J Am Soc Echocardiogr
(2003)
Right ventricular function and failure: report of a National Heart, Lung, and Blood Institute working group on cellular and molecular mechanisms of right heart failure
Circulation
Quantitative assessment of alterations in regional left ventricular contractility with color-coded tissue Doppler echocardiographyComparison with sonomicrometry and pressure-volume relations
Circulation
Doppler-derived myocardial strain rate is a strong index of left ventricular contractility
Circulation
Longitudinal strain quantitates regional right ventricular contractile function
Am J Physiol Circ Physiol
Longitudinal but not circumferential deformation reflects global contractile function in the right ventricle with open pericardium
Am J Physiol Heart Circ Physiol
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.