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Right ventricular diastolic function indices in pulmonary hypertension of different degree in patients with chronic pulmonary heart disease

Sumin A. N., Arkhipov O. G.

Keywords: right ventricular diastolic dysfunction, pulmonary hypertension, pulmonary heart disease

DOI: 10.18087/rhfj.2012.1.1625

Relevance. Right ventricular diastolic dysfunction has clinical and prognostic value in patients with pulmonary pathology. RV filling parameters are determined by many factors. This is why study of several indices, reflecting different diastole components, makes sense. Objective. Study of RV diastolic function indices in patients with pulmonary pathology with different degrees of pulmonary hypertension (PH) manifestation. Materials and methods. Examination of 226 patients with pulmonary pathology was performed (including 188 male, age 61.6±7.6 years). Depending on PH manifestation degree the following groups were made: patients without PH (MPAP <25 mm Hg, n=89), PH1 group (MPAP 25–30 mm Hg, n=64), PH2 group (MPAP 31–40 mm Hg, n=41), and PH3 group (MPAP ≥40 mm Hg, n=32). In these groups, the following indices of RV diastolic function were evaluated: early and late transtricuspid flow velocities (ET, AT), tricuspid annular diastolic velocity by Doppler tissue imaging (EAT, AAT), early diastolic flow velocity of RV filling (tricuspid flow velocity), and Tei index. Results. Groups of patients with different PH manifestation degrees did not differ by such indices as, ET / АT and EAT / AAT ratios. At the same time tricuspid flow velocity was less in PH groups in comparison with the group without PH (Н=11.6; p=0.009), and in PH3 group this decrease was almost 20 % in comparison with patients without signs of PH (р<0.05). Tei index also progressively increased with increase of the pulmonary artery pressure (Н=21.9; p=0.0001), it reflects integral (systolic and diastolic) performance of the right ventricle. This index was 32 % higher in PH2 group and 51 % higher in PH3 group in comparison with PH1 group (p<0.05 in both cases). Correlation analysis showed a feedback between tricuspid flow velo­city and pulmonary artery mean (r= –0.28) and systolic (r= –0.34) pressure. Tei index was revealed to have direct correlations with PH degree (r=0.41 and r=0.52 relatively). Conclusion. In patients with chronic lung disease, increase of the pulmonary hypertension is accompanied by the progressive decrease of RV diastolic function index – early diastolic filling velocity increase of Tei index, which reflects general performance of the right ventricle.
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Sumin A. N., Arkhipov O. G. Right ventricular diastolic function indices in pulmonary hypertension of different degree in patients with chronic pulmonary heart disease. Russian Heart Failure Journal. 2012;13(1):13-18

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