Pulmonary Hypertension In Patients With Cardiac Function Change Of Clinical Research

Objective:To evaluate diagnostic value of echocardiographic measurements for reflecting right ventricular (RV) function in pulmonary hypertension (PH) using right heart catheterization (RHC)-derived cardiac index (CI) as a gold standard.Methods:A total of forty-three consecutive patients with PH and twenty-seven age-and gender-matched healthy subjects were prospectively included. All patients underwent echocardiography and thirty-nine of these patients underwent RHC examination within one week. All patients with PH and healthy subjects underwent detail echocardiography examination. Measure tricuspid annular plane excursion (TAPSE), systolic lateral tricuspid annular motion velocity (TV,al), RV fractional area change (RVFAC), right ventricular myocardial performance index (RVMPI). The differences between patients with PH and healthy subjects were compared. Association between five echocardiography derived parameters of RV function and RHC-derived CI were evaluated. Diagnostic accuracy of these indices was compared by the receiver operating characteristics (ROC).Results:All four echocardiography-derived parameters were correlated with RHC-derived CI (TAPSE:r=0.727, P<0.001; TViat:r=0.508, P=0.002; RVFAC: r=0.328, P=0.034; RVMPI:r=-0.445, P=0.007). Compared with the other indices, TAPSE exhibited the highest correlation coefficient. The area under the receiver operating characteristic curve (AUC) of TAPSE<15.65mm for CI<2.0L/min/m2was0.858(sensitivity:85.0%; Specificity:73.3%) by the ROC.Conclusion:Echocardiographic measurements are promising noninvasive indices of RV function in patients with PH. In particular, TAPSE is superior to other indices in accuracy. Objective:To evaluate left ventricular (LV) geometry and function in patients with pulmonary hypertension (PH) by means of echocardiography and speckle tracking imaging (STI).Methods:Thirty-nine patients [age,18-62(33.2±10.6)years;66.7%women)]with pulmonary hypertension (PH) were prospectively collected, and patients with intrinsic LV diseases were excluded. All the patients included underwent echocardiography. In addition, thirty-five of these patients underwent right heart catheterization (RHC) examination within one week. Twenty-seven age-and gender-matched healthy subjects were included as control group. Thirty-nine patients with PH and27healthy subjects underwent detailed echocardiography examination. Right ventricular function, left ventricular diastolic function and left ventricular systolic function were evaluated. Parasternal mid short axis view, apical four-chamber view were obtained. Global circumferential systolic strain (GCSS), global radial systolic strain (GRSS), global longitudinal systolic strain (GLSS) were calculated with software of speckle tracking imaging. Systolic circumferential strain (CS), radial strain (RS), longitudinal strain (LS) of interventricular septal (1VS) and LV lateral wall (LAT) were also calculated. The differences between two groups were compared. Association between echocardiography indices of LV diastolic function and RHC-derived hemodynamic indices were evaluated.Results:Right ventricular dysfunction happened in PH group. Left ventricular diastolic dysfunction also happened in PH group. E, E/A, E’, E’/A’were positively correlated with RHC-derived CI. E/A, E’/A’were negatively correlated with RAMP. E’was negatively correlated with PCWP. There was no significant difference in left ventricular ejection fraction (LVEF) between normal subjects and patients with PH (66.48%±6.38%vs65.26% ±4.01%,P>0.05),however,the GCSS(-15.66%±3.67%vs-18.56%±2.16%, P<0.01),GRSS(15.54%±5.35%vs30.03%±9.64%, P<0.01)and GLSS(—16.18%±4.35%vs-20.91%±2.96%,P<0.01)were lower than normal subjects.Not only systolic IVS CS,RS,LS reduced,but also LV systolic lateral wall CS(一14.44%±3.57$vs-18.76%±3.23%,P<0.01),RS(18.56%±7.90%vs32.78%±13.45%,P<0.01)and LS(-17.89%±5.54%vs-22.41%±4.44%,P<0.01)were lower than normal subjects.Conelusion:Chronic RV pressure overload directly affects RV geometry and function.further influences LV geometry and impairs LV function of patients with PH.Left ventricular diastolic dysfunction happens in moderate or severe patients with PH.The LV diastolic dysfunction is correlated with severity of right ventricular dysfunction. Although LVEF is normal,LV myocardial dysfunction happens.