Abstract 4389: Right Ventricular Diastolic Function in Pulmonary Hypertension

Abstract

Background : Left ventricular diastolic dysfunction is associated with worse outcomes in patients with severe chronic elevation in pulmonary artery systolic pressures (PASP); however, little is known if right ventricular diastolic dysfunction (RVDD) is also present in these patients. Methods : Color M-mode to measure RV propagation velocity (Vp) and tissue Doppler imaging (TDI) of the tricuspid valve annulus (TVa) were done in 21 patients (Group I: mean age 54 ± 15, mean PASP 80 ± 31 mmHg) and in 19 healthy individuals (Group II: mean age 51 ± 14 years, PASP 30 ± 7 mmHg). All subjects were in normal sinus rhythm and normal left ventricular systolic function. Results : Despite elevation in PASP, Group I RV systolic function measured by both TVa excursion (2.01 ± 0.7 cm) and TVa systolic velocity (0.10 ± 0.04 cm/s) were no different than Group II (2.5 ± 0.5 cm and 0.12 ± 0.03 cm/s, respectively). Even though there was no difference in either early (0.11 ± 0.04 versus 0.13 ± 0.04 cm/s) versus late (0.15 ± 0.05 versus 0.13 ± 0.04 cm/s) diastolic velocities by TDI; a lower Vp was seen in Group I (28 ± 12 cm/s) than Group II (41 ± 15 cm/s, p < 0.01) with a significantly shorter diastolic interval (259 ± 90 versus 390 ± 80 ms, p < 0.0001). Representative color M-mode images are shown in the Figure . Conclusions : Routine use of TVA TDI appears to be less useful than color M-mode to appreciate RV diastole as it shows a slower Vp with flows shifted later in diastole. In addition, these patients also demonstrate a shorter diastolic interval. Further studies are now required to prospectively assess the effects of pulmonary hypertension in clinical outcomes in patients manifesting RVDD. Figure. (A) Color M-mode image of a patient artery systolic pressures demonstrating predominantly early diastolic flow. (B) Color M-mode image from a patient with pulmonary hypertension showing predominantly late diastolic flow.