Prognostic Value of RV Tissue Annular Velocity in Chronic Pulmonary Artery Hypertension

Abstract

Background: Elevated afterload in chronic pulmonary artery hypertension (PAH) leads to sequence of events resulting in right ventricular (RV) hypertrophy, dilatation and eventual RV dysfunction. In last two decades, great emphasis has been laid on the right ventricular function for the prognosis of PAH. Hence, RV functional assessment is essential for assessing prognosis and monitoring therapeutic interventions in PAH patient. The purpose of this study to evaluate the prognostic value of pulse wave tissue Doppler imaging (PW-TDI) in chronic PAH patients. Methods: Eighty five patients (85) with chronic pulmonary artery hypertension were analysed. Patients were divided into two groups according to pulmonary artery systolic pressure by 2-D echocardiography as follows: group A (n = 56) included mild to moderate PAH with pulmonary artery systolic pressure less than 70 mm of mercury and group B (n = 29) included severe pulmonary artery pressure with pulmonary artery systolic pressure of more than equal to 70 mm of mercury. RV dysfunction was present in 8.9% (n = 5) & 24.1% (n = 7) of patients in group A and B respectively (p = 0.01). Tricuspid annulus plain systolic excursion (TAPSE) was measured at tricuspid annulus in M mode and pulse wave tissue Doppler imaging (PW-TDI) was performed and early diastolic annular velocities were recorded at the septal and lateral tricuspid annulus in all patients. Patients were followed for six months. Results: The present study demonstrates an inverse correlation between right ventricular (RV) performance indices e.g., TAPSE, RVPW-TDI early diastolic annular velocity (E`) and systolic pulmonary artery pressure in both groups of PAH patients. TAPSE was 20.45 mm and 18.13 mm (p < 0.05) whereas E` lateral annular velocity was 16.05 cm/sec and 13.33 cm/sec (p < 0.05) for group A and B patients respectively. Similarly, TAPSE was 15.9 mm and 10.2 mm (p < 0.05) whereas E` lateral annular velocity was 20.6 cm/sec and 13.6 cm/sec (p < 0.05) for normal RV function and RV dysfunction patients respectively. Lower TAPSE and RV TDI early diastolic annular velociHow to cite this paper: Shrivastava, P., Jha, P.K., Ete, T., Saha, S., Megeji, R.D., Kavi, G., Das, C.K., Kamei, S., Nath, D., Warjri, S.B., Sivam, R.K., Kapoor, M., Malviya, A. 2/11OALib Journal ties had more re-hospitalization (p < 0.05). Conclusion: The measurement of TAPSE by M-mode and RV TDI early diastolic annular velocities is a non-invasive, effective, simple and reproducible method that correlated well with pulmonary artery systolic pressure (PASP) and right ventricular function.