P4370Doppler echocardiography, RV Strain and 3D RV Imaging in diagnosis of Acute mountain sickness

Abstract

Abstract Introduction Right Ventricular (RV) strain and 3D RV ejection fraction sensitivity and specificity has made it a practical and reliable test to detect Acute mountain sickness. All previous studies have been done mainly using M Mode and 2D Echo. Hence it was conceived that 3D Echocardiography would be a better option. Regardless of the type of Acute Mountain Sickness (AMS), the echocardiographic evidence is always the same: Severe Pulmonary hypertension. The visual analysis of these abnormalities requires a trained operator. This operator-dependence has promoted the search for a semiautomatic method to reduce limitations of Echocardiography and improve test accuracy Purpose The purpose was to study AMS by 3D Echocardiography Methods and results Two dimensional echocardiography with RV strain analysis by speckle tracking echocardiography along with 3D RV ejection fraction was done in nine patients with AMS who were tourists on unplanned, unacclimatized assent to Pangong lake, situated near Leh-Ladakh in the Himalayas, approximately at the height of 4350 meters above sea level and six highlanders, living in Leh-Ladakh. Figure 1A shows the map of the Pangong Lake, B. Shows features of Acute Pulmonary Edema in the Chest X-ray from a patient with AMS, C. Shows the TAPSE (Tricuspid Annular Plane Systolic Excursion) D. Shows the Speckle tracking derived RV Free Wall strain (From a software made for LV) and E: Methodology to derive 3D RV Ejection Fraction. 3D Echocardiographic Equipment with LV strain (which was modified to derive RV Free wall strain) and 3D RV Ejection Fraction software was used for acquisition of images and offline analysis was done. TAPSE, FAC, RV Free wall strain and 3D RV EF were consistently lower in patients with AMS than in persons living in high altitude (High landers). TR peak gradient, RV EDV index, RV ESV index were elevated in AMS patients compared to High landers. Table 1. Table 1 Age Sex M/F 3D RV EF% TAPSE (mm) FAC TRP E/e' RVFW Strain RV EDVI (ml/m2) RV ESVI (ml/m2) AMS (9) 40.2±2.3 5/4 36±3.2 16±1.7 38.2±2.7 49.2±7.6 5.4±1.2 14±1.9 55±3.7 35±2.4 High Landers (6) 53.6±3.7 5/1 45±2.3 20±2.7 46.9±4.7 26.52±6.7 7±1.7 28±2.2 52±4.1 29±2.8 RV: Right Ventricle; EF: Ejection Fraction; TAPSE: Tricuspid Annular Plane Systolic Excursion; FAC: Fractional Area Change; TRP: Tricuspid Regurgitation Peak gradient; E: Mitral E Velocity; e' Medial mitral Tissue doppler e velocity; FW: Free Wall; EDVI: End Diastolic Volume Index; ESV: End systolic volume index. Figure 1 Conclusion Strain or myocardial deformation analysis based on two-dimensional (2D) speckle tracking and 3D RV ejection fraction is feasible even in the remote altitudes apart from standard M Mode and Doppler measurements and allow accurate quantification in analysis of acute mountain sickness.