Doppler Myocardial Imaging for Early Detection of Right Ventricular Dysfunction in Patients With Pulmonary Hypertension

Background: In pulmonary hypertension (PHT), right ventricular (RV) function affects treatment strategy and prognosis. Doppler myocardial imaging (DMI) has the potential to detect early RV dysfunction. Methods: Regional RV function was prospectively assessed in 110 patients without primary structural heart disease, including patients with known PHT (group I; n = 40; mean age, 59 ± 16 years) and tricuspid regurgitation (TR) velocity ≥ 3 m/s; group II (n = 30; mean age, 57 ± 13 years), with TR velocity > 2.5 to < 3.0 m/s; and group III (n = 40; mean age, 56 ± 9 years), with normal echocardiographic results and TR velocity ≤ 2.5 m/s. All underwent the assessment of RV function with the RV index of myocardial performance (RIMP), RV fractional area change, tricuspid annular plane systolic excursion, and DMI of the interventricular septum and RV free wall. Results: Basal RV peak systolic strain and strain rate (SR) were correlated with TR velocity (r = 0.59 and r = 0.49, respectively; P < .0001) and with RIMP (r = 0.53 and r = 0.45, respectively; P < .0001). Despite similar RV functional parameters in groups II and III, basal RV strain and SR and basal septal SR were significantly attenuated in group II (-27.8 ± 5.1% vs -31.1 ± 5.6%, P = .016; -1.6 ± 0.4 vs -1.9 ± 0.5 s^-1, P = .004; and -1.2 ± 0.2 vs -1.4 ± 0.1 s^-1, P < .001, respectively). Although 6 patients in group I had normal RIMP values, this subgroup had attenuated SR and strain compared with group III. Conclusions: RV and septal systolic strain and SR may allow the recognition of early RV dysfunction in patients with PHT, even when conventional RV systolic parameters are normal.