Evaluation Of Right Ventricular Global Function Using Tissue Doppler Imaging In Rheumatic Heart Disease

Tei index is a research focus reflecting right ventricular global function for the past few years. Traditional measurements of Tei index comes from the parameters of Doppler blood stream in tricuspid orifice. Tissue Doppler imaging provides a new method for evaluating ventricular function quantitatively. Its application in detecting left ventricular function has already obtained clinical affirmation, but isn't mature in evaluating right ventricular function. In this study, we try to detect right ventricular global function in rheumatic heart disease by TDI-derived Tei index. At the same time, we evaluate systolic and diastolic function using velocity and time parameters derived from pulsed wave-tissue Doppler imaging. This research has two parts:Part 1 Study on Right Ventricular Global Function of Patients with Rheumatic Heart Disease Using TDI-derived Tei Index and it's Effect FactorsObjective To investigate the value of Tei index derived from pulsed wave-tissue Doppler imaging (PW-TDI) in evaluating right ventricular global function of patients with rheumatic heart disease(RHD), and to analyze the relationship between Tei index and age, heart rate .Methods A total of 36 patients with RHD and 24 volunteers were involved in this study. Some traditional ultrasonic parameters of right heart, time parameters and TDI-derived Tei Index were measured and compared. PW-TDI data were acquired from tricuspid annular on apical four-chamber view.Results(1) Group B (n=16) had characteristic echocardiographic appearance of right ventricular dysfunction, group A (n=20) were judged as normal right cardiac performance. However, the TDI-derived Tei Index of group A and B (0.68±0.13 and 0.72±0.09) were different significantly compared with the healthy volunteers (0.35±0.07, P<0.01).(2) In volunteers, Tei index was independent on age(r=0.10, P>0.05) and heart rate( r=0.11, P>0.05);but in patients with RHD, Tei Index correlated positively with age (r=0.42, P<0.05), and was independent on heart rate(r=0.10, P>0.05).Conclusions Tei index measured by PW-TDI acquired from tricuspid annular is a sensitive indicator of right ventricular global function.Part 2 Evaluation of Right Ventricular Global Systolic and Diastolic Function by pulsed wave-Tissue Doppler Imaging in Rheumatic Heart DiseaseObjective To investigate the value of parameters derived from pulsed wave-tissue Doppler imaging (PW-TDI) in evaluating right ventricular global systolic and diastolic function of patients with rheumatic heart disease (RHD).Methods A total of 36 patients with RHD and 24 age matched healthy volunteers were involved in this study. Some traditional ultrasonic parameters of right ventricular were measured .at the same time, PW-TDI parameters acquired from tricuspid annular on apical four-chamber view were detected. The TDI-derived parameters included systolic peak velocity (Vs), pre-ejection time (PET), ejection time (ET), PET/ ET, early-diastolic peak velocity (Ve), late-diastolic peak velocity (Va), ratio of Ve and Va (Ve/Va), isovolumetric relaxation time (IRT). then compared with those of the healthy volunteers .Results(1) In 36 patients with RHD, Group A1 (n=7) had a little tricuspid backstreaming but no pulmonary hypertension, group A2 (n=13) had different level of pulmonary hypertension but no obviously hypertrophy of right heart, group B (n=16) had evident pulmonary hypertension and hypertrophy of right heart.(2) In those of right ventricular functional parameters in volunteers, Vs was independent on age (P>0.05);but Ve, Ve/Va correlated negatively with age (P<0.05),Va was positively independent on age (P<0.05).(3) Compared with the healthy volunteers, the parameters reflected systolic function, Vs, PET, PET/ET in group A1 had no obviously difference, but the parameters reflected diastolic function, Ve, Ve/Va were significantly decreased(P<0.05); In group A2 and group B, Vs and Ve, Ve/Va all decreased significantly; PET, PET/ ET increased significantly compared with the healthy volunteers(P<0.05).Conclusions(1) The right ventricular dysfunction occurred before appearance of pulmonary hypertension, and mainly reflected the decrease of diastolic function in patients with RHD. After the appearance of pulmonary hypertension, right ventricular global systolic and diastolic function are all impaired.(2) In all functional parameters measured by PW-TDI acquired from tricuspid annular, Vs, PET, PET/ET can sensitively reflect the change of right ventricular systolic function; Ve, Ve/Va are sensitive indicators of diastolic functional change.(3) We ought to allow for the age factor when estimate right ventricular diastolic function using Ve and Ve/Va .