Impact of pulmonary hypertension on biventricular functions tissue doppler echocardiographic study

Abstract

BackgroundPulmonary hypertension (PH) essentially involves the right heart. Also left ventricular (LV) systolic and diastolic functions may be affected. Objectives: The aim of this study was to investigate the effect of pulmonary hypertension on both right and left ventricular systolic and diastolic functions by tissue doppler echocardiography. MethodsA total of 50 patients with PH in Echocardiographic assessment at Echocardiographic Unit, Assuit University Hospital, Al-Azhar University and 20 controls were included in this study between May 2012 and June 2014. All patients underwent electrocardiography (ECG), conventional and tissue doppler echocardiography (TDI). The patients were divided into 3 subgroups according degree of PH: patients with mild PH (group Ia, n=15), moderate PH (group Ib, n=20) and severe PH (group Ic, n=15). ResultsThere is statistically significant difference between the two groups (cases and control) as regard mPAP, Pul.AAT, left ventricular diastolic function parameters (LV MV E/E′ and LV IVRT), right ventricular diastolic function parameters (RV TV E/E′ and RV IVRT), right ventricular tissue doppler derived MPI and ventricular dyssynchrony measured by IVDM, RV-LV LW time to onset intervals (Smo) and RV LW-Sept. time to onset methods. There is no statistically significant difference between the two groups (cases and control) as regard LV LW-Sept. time to onset (Smo) interval which assess Left intraventtricular synchronicity. There is statistically significant difference between the subgroups in group 1 (cases) as regard to LV diastolic function as measured by MV E/E′, DT and IVRT methods. RV diastolic function as measured by TV E/E′, DT and IVRT methods. RV systolic function as measured by RV FAC, IVA, TAPSE. Systolic velocity (S) wave and RV MPI methods. Means LV and RV functions are affected by increased pulmonary pressure and that effect become worse with increasing pulmonary pressure (increasing PH lead to increasing deterioration of LV and RV functions). There is no statistically significant difference between the subgroups in group 1 (cases) as regard LV systolic function measured by LV MPI and average systolic (S) wave methods. ConclusionTDI-derived methods more accurate and sensitive than conventional Echo pre-ejection period method for assessment of inter-ventricular mechanical delay.