Abstract:

Objective   To evaluate the change of right ventricular function in patients with pulmonary hypertension (PH) using tissue Doppler imaging(TDI). Methods   150 patients dignosised with PH were divided into three groups according to the level of PH.Pulsed wave TDI（PW-TDI）velocity parameters including isovolumetric contraction velocity (IVC)， systolic peak velocity (s′)，early diastolic peak velocity(e′)， late diastolic peak velocity(a′),velocity-time integral of s, e and a(VTIs,VTIe,VTIa)were measured. Under the apical four-chamber view，the peak of early diastolic velocity (E)and late diastolic velocity (A) of the  tricuspid flow spectrum that detected by pulsed wave Doppler were measured. Meanwhile，the parameters above were compared with those of the controls.  Results   All velocity paraments of anterior tricuspid annular were extremely higher than those of posterior tricuspid annular,and these paraments of posterior tricuspid annular were significant higher than those of septal tricuspid annular in the control group and the PH group (P＜0.001). IVC, s′, VTIs of anterior tricuspid annular were higher than those of  middle segment of right ventricular free wall in the control group and the PH group（P＜0.05）. Compared with those of tricuspid anterior value in the control group, VTIe, e′/a′, E/A were found to be lower and a′, VTIa to be higher in the patients with PH（P＜0.05）.There was no significant difference in IVC, s′, VTIs and e, between the two groups. Compared with those of the controls，IVC, s′ and VTIs increased in the patients with mild PH and decreased in the patients with severe PH. e, decreased in the severe PH group.Moderate and severe PH showed decreasing VTIe. a′ and VTIa were elevated in the mild and moderate PH groups. Ratio of e′/a′ and E/A decrased in the mild，moderate and severe PH groups than that in the controls（P＜0.05）. Correlations were found between the e′/a′, of tricuspid anterior value and E/A of tricuspid flow detected by PW-TDI in the PH group（r=0.382，P＜0.001）. The detection rate of e′/a′＜1 （42.9%）was higher than that of E/A＜1（15.2%）（χ2=21.55，P＜0.001）. Conclusions   Pulmonary hypertension leads to the dysfunction of right ventricular function. Diastolic dysfunction starts in mild PH and right ventricular systolic dysfunction occurs in patients with severe PH. Velocity parameters of anterior tricuspid annular by PW-TDI can reflect right ventricular function of patients with PH sensitively and accurately.

Key words: Tissue Doppler imaging; Echocardiography; Pulmonary hypertension; Right Ventricular function