Temporal differences in ejection between right and left ventricles in chronic pulmonary hypertension: a pulsed Doppler study

Abstract

Chronic pulmonary hypertension (cPH) is known to alter right ventricular (RV) deformation and cause mechanical dyssynchrony. Since not all echocardiographic laboratories are equipped with sophisticated imaging tools, we decided to determine if Doppler would be useful to detect temporal differences between the ejection of the right and left ventricle (LV) as a result of cPH using pulsed outflow tract (RVOT and LVOT) spectral signals. Data was collected from 30 patients without PH (Group I: 53 ± 7 years and 31 ± 5 mmHg) and from 40 patients with cPH (Group II: 53 ± 13 years; P = NS and 82 ± 24 mmHg; P < 0.00001). Group II patients had a longer temporal delay from onset between RVOT and LVOT (23 ± 12 ms vs. 0 ± 0 ms; P < 0.0001) with a significantly shorter temporal difference between RVOT and LVOT spectral signals to reach maximum peak of ejection (27 ± 24 ms vs. 61 ± 23 ms; P < 0.0001) than Group I. In addition, Group II had a statistically lower RVOT VTI value (0.14 ± 0.05 cm vs. 0.17 ± 0.03 cm; P < 0.01). Our data seems to suggest that increasing severity of PH mainly affects ejection of the RV resulting in noticeable temporal alterations in both time of onset as well as time to reach maximum peak ejection between RV and LV. More studies are now required to determine the utility of obtaining these measurements prospectively in the follow-up and treatment of cPH patients.