Evaluation Of Right Ventricular Function In Patients With Pulmonary Hypertention By Echocardiography

Objective:1,To explore the significance of tissue Doppler imaging(TDI) that measures Tei index of right ventricular function with pulmonary hypertension,and compares with the normal by the Tei index.2,Tei index obtained by TDI at three observation points,separate the anterior tricuspid and septal tricuspid attachment points in the apical four chamber view and the posterior attachment of parasternal right heart two chamber,and compared with the 3 points to choose the appropriate point in TDI that measured right ventricular Tei index.3,To explore the feasibility and the superiority of the right ventricular Tei index in evaluating the right ventricular function by comparison with other indexes.Materials and methods:86 patients' with pulmonary hypertension mean age was 21.06±16.30,and were divided into 3 groups according to the level of pulmonary hypertension(low-grade pulmonary hypertension 30 cases, medium-grade pulmonary hypertension 30 cases,high-grade pulmonary hypertension 26 cases).Control group is consisted 32 subjects with normal pulmonary hypertension.All right ventricular function index were examed by tranasthoracic echocardiography using Philips IE33 imaging(Agilent Company, USA).The tricuspid inflow velocity profile in the apical four chamber view and the pulmonary orifice velocity profile in the parasternal short axis view of the aortic valve level were recorded.The interval between cessation and onset of the tricuspid inflow measured from the tricuspid inflow velocity profile with pulsed-wave Doppler echocardiography is a₁.The interval b₁ is ejection time which is measured from the right ventricular outflow Doppler signal,a₁-b₁ is the sum of right ventricular isovolumetric contraction time and isovolumetric relaxation time.The right ventricular Tel index is calculated as(a₁-b₁)/b₁.The pulmonary arterial systolic pressure from the tricuspid regurgitation velocity is calculated.Then using TDI recorded the tricuspid annulus movement and calculated Tei index and the velocity of s,e and a.The movement include systolic wave s,early diastolic wave e and late diastolic wave a in every period. The interval between cessation of late diastolic wave a to onset of the next early diastolic wave e is a₂.The interval between onset to cessation of the wave s is b₂。The right ventricular Tei index is calculated as(a₂-b₂)/b₂.Result:1,The right ventricular Tei index in patients with pulmonary hypertension measured by TDI was higher than the control group significantly (P＜0.05).Furthermore a better correlation was observed between right ventricular Tei index measured by TDI with PASP(r=0.75,P＜0.01)。2,The Tei index of low-grade and medium-grade pulmonary hypertension measured by CDFI was lower than the control group,Considering haemodynamics affecting,the Tei index was measured with relative accuracy,but the Tei index of high-grade pulmonary hypertension group was higher than control group significantly(P＜0.05).3,The Tei index of low-grade and medium-grade PH groups measured by TDI at septal tricuspid and posterior tricuspid had no significant difference.Another groups Tei index had significant difference(P＜0.05).4,Except the groups of PH septal tricuspid and posterior tricuspid velocity of a was lower than the contrast,the remnant groups of PH velocity of s,e and a had no significant difference to the contrast.Conclusions:1,The heightening of right ventricular Tei index means the globle right ventricular functiong is degrading.2,The right ventricular Tei index of PH is higher than the normal,and the level of heightening has positive correlation with PH.3,The Tei index measured by TDI at anterior tricuspid attachment point in apical four chamber view is better than the septal tricuspid attachment point in the apical four chamber view and the posterior attachment of parasternal right heart two chamber.4,The Tei index measured by TDI is sensitive and convenient to evaluate the right ventricular function,as the same the heart shape,heart rate andpreload et al have no effect to it.It can exactly evaluate the patients with PH of right ventricular function,and it is more surpass and exact to the other indexes which are also measured from right ventricular function.5,The right ventricular Tei index measured by TDI is also good to reflect the right ventricular function,and even more convenient and exact.It is improvement and useful recruitment of the right ventricular Tei index measured by CDFI.6,The right ventricular Tei index can reflect the degree of PAH in some extent,and it provides a new method to estimate pulmonary artery pressure (PAH)by echocardiography,and it is helpful to estimate PAH with non-invasive methods at clinic as well as helpful to judge the extent and prognosis of disease.