QUANTITATIVE ASSESSMENT OF RIGHT VENTRICULAR DYSFUNCTION BY TISSUE DOPPLER IMAGING

Aim of the present study was to establish whether high frame rate tissue Doppler imaging (TDI, Toshiba corp.) may provide quantitative assessment of global and regional right ventricular (RV) systolic and diastolic function, still a challenging clinical problem. We studied 27 patients (pts), aged 51 +/- 11 years, with various forms of heart disease (pulmonary valve stenosis in 8, cor pulmonare in 7, atrial septal defect in 7, right ventricular infarction in 5). 13 pts -group “1”- had RV dysfunction (RV fractional area change < 45%), 11 pts -group “2”- had RV hypertrophy from pressure overload. 13 subjects with no signs of heart disease were used as a control group. Peak mean systolic (S) and diastolic (E,A) wall velocities were acquired from the 4-chamber view in the myocardia (septum -IVS- and free wall -FW-). TDI wall velocities during systole (Sa), early relaxation (Ea) and atrial systole (Aa) were also measured in the tricuspid annulus. Satisfactory TDI data could be obtained in all pts at end expiration, independent of quality of RV wall motion. Compared to controls, group “1” pts had lower peak mean FW velocities (S=5.6 +/- 1.7 vs 8.4 +/- 2.1 cm/s – p<0.005 –; E=5.5 +/- 1.9 vs 9.3 +/- 2.4 cm/s – p< 0.001 –; A= 3.4 +/- 1.4 vs 3.6 +/- 1.8 cm/s – p=NS –) and lower annulus velocities both in systole and diastole (Sa =5.2 +/- 1.3 vs 8.7 +/- 1.5 cm/s – p<0.001 – ; Ea = 5.9 +/- 1.9 vs 13.3 +/- 2.4 cm/s – p< 0.001 – ; Aa = 7.9 +/- 2.1 vs 7.2 +/- 2.3 cm/s – p=NS – ). Also, group “1” pts had lower peak mean FW S and E velocities compared to IVS wall velocities (p < 0.005). Group “2” pts had preserved systolic velocities but decreased regional and annular early diastolic velocities suggesting impaired relaxation (Ea/Aa 0.83 +/- 0.27 vs 1.62 +/- 0.33 – p<0.0001 – ). Thus, TDI was useful in evaluating regional systolic and diastolic RV abnormalities and could differentiate hypertrophic from dysfunctional right ventricle.