573 Routine evaluation of three echo-Doppler and DTI indexes provides a simple and accurate measure of right ventricular function

Abstract

Echocardiographic assessment of the right ventricular (RV) systolic function is very difficult owing to the complex geometric shape of the ventricle. In the last years tricuspidal annular plane systolic excursion (TAPSE), Doppler tissue imaging evaluation of systolic tricuspidal annular motion (SDTI) and percentage of systolic change in area in the apical four-chamber view (FSA) have been proposed as useful methods to analyse RV function, however they have been validated in small series of cases Aims of this study were: a) to evaluate the routine use of these 3 echo-Doppler and DTI parameters as a measure of RV systolic function in a series of 1000 consecutive patients; b) to determine the relationship between these and other echo-Doppler RV and LV function indexes. During a routine transthoracic examination TAPSE (mm), SDTI (cm/sec) and FSA (%) were measured in the apical view and correlated with the systolic pulmonary pressure (SPP, mmHg, calculated through the tricuspid velocity and inferior vena cava collapsability) and the left ventricular ejection fraction (LVEF, %). These data were compared in normal subjects (Group 1, 218 cases) and patients (Group 2, 782 cases). Results: In all cases measurements of these 3 parameters were easily and rapidly (mean time 3±1’) obtained, with a low inter- and intra-observer variability. TAPSE (20± 5v s 24 ± 4), SDTI (16 ± 6v s 19 ±4) and FSA (50±11 vs 54±10) were significantly lower in Group 2 in comparison with Group 1. Each parameter correlated with the other two and with LVEF. TAPSE and SDTI correlated negatively to SPP. Subanalysis of selected groups showed that in pts with inferior myocardial infarction TAPSE (18±5) and SDTI (15±4) were significantly reduced without any correlation with LVEF. Interestingly, in pts after cardiac surgery TAPSE (13±2) and SDTI (13±2) were significantly lower in comparison with the pre-operatory values (23± 4p <0.001 and 20± 5p <0.001, respectively), while FSA (from 49.5±12 to 51±11n.s.), LVEF (from 61±10 to 58.5±8 n.s.) and SPP (34.5 ±5 vs33.5±7 n.s.) did not change. In conclusion: a) TAPSE, SDTI and FSA may be easily and rapidly included in a routine echo-Doppler examination; b) values of these indexes in a large series of cases showed differences in normal subjects from patients; c) TAPSE and SDTI are very sensitive indexes of RV systolic function showing changes of longitudinal shortening of the RV in pts with inferior myocardial infarction and after cardiac surgery independently on LVEF and SPP values.