Efficacy of Isovolumic Acceleration in Assessing Right Ventricular Function in Pulmonary Hypertension

V S Bharathi,Adikesava Naidu Otikunta,Syed Imamuddin,Y V Subbareddy,Ashok Thakkar,K Laxman Rao

doi:10.4236/ijcm.2014.512093

V S Bharathi, Adikesava Naidu Otikunta + Show 4 more

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https://doi.org/10.4236/ijcm.2014.512093

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Abstract

Object&#105ve: The aim of the study was to determine usefulness of isovolumic acceleration to assess right ventricular function in patients with pulmonary hypertension. Background: Right ventricular dysfunction is a powerful predictor of adverse outcomes in patients with pulmonary hypertension. Although isovolumic acceleration is a sensitive and relatively load-independent parameter for ventricular contractile function, it has not been widely used. So, the aim of the study was to determine the usefulness of isovolumic acceleration in assessing right ventricular function in patients with pulmonary hypertension. Methods: A single center, prospective observational case-control study has been carried out for the period of one year at Osmania general hospital (Hyderabad). A total of 32 consecutive patients with pulmonary hypertension and 32 age matched healthy controls were recruited in the study as per the inclusion and exclusion criteria of the study. Receiver operator characteristic curves were used to study sensitivity, specificity, positive predictive value, negative predictive values as well as pearson’s correlation coefficients. Results: The results of the study showed that isovolumic acceleration has good significant correlation with right ventricular fractional area change (r = 0.554, p = 0.001) and tissue Doppler myocardial performance index (r = -0.599, p = 0.001) whereas a lesser but significant correlation was observed with tricuspid annular plane systolic excursion (r = 0.327, p = 0.034). Isovolumic acceleration showed higher specificity (81%) and positive predictive value (88%) in diagnosing right ventricular dysfunction in pulmonary hypertension compared to tricuspid annular systolic excursion velocity and tissue Doppler myocardial performance index parameters. Therefore isovolumic acceleration may be a better variable for diagnosing right ventricular dysfunction. Conclusions: Isovolumic acceleration is a sensitive and specific marker of right ventricular function in pulmonary hypertension.

Highlights

The assessment of right ventricular (RV) function is essential in patients with pulmonary hypertension (PH) as RV dysfunction is a powerful predictor of adverse outcomes
The ability of the RV to adapt to the progressive increase in pulmonary vascular resistance (PVR), which is usually associated with changes in the pulmonary vasculature during PH, is the main determinant of a patient’s functional capacity and survival [1]
Our study aims to determine the efficacy of Isovolumic acceleration (IVA) in assessing global RV systolic function in patients with PH

Summary

Introduction

The assessment of right ventricular (RV) function is essential in patients with pulmonary hypertension (PH) as RV dysfunction is a powerful predictor of adverse outcomes. The ability of the RV to adapt to the progressive increase in pulmonary vascular resistance (PVR), which is usually associated with changes in the pulmonary vasculature during PH, is the main determinant of a patient’s functional capacity and survival [1]. Tissue Doppler echocardiography (TDE) has been used to assess RV global and regional systolic function [2]. Isovolumic acceleration, derived from tissue velocity, is a load-independent measure of contractility and correlates with right ventricular end-systolic elastance [3]. This correlation is less pronounced in clinical studies [4]

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