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Published on: February 3, 2014
Assessment of right ventricular function using tissue Doppler imaging in infants with pulmonary hypertension
Neil Patel1, John F Mills, Michael M H Cheung
1Royal Hospital for Sick Children, Glasgow, UK. neil.patel@nhs.net
Insights
Tissue Doppler imaging (TDI) reveals reduced right ventricular (RV) function in infants with pulmonary hypertension (PHT). This non-invasive assessment highlights impaired systolic and diastolic velocities, suggesting potential therapeutic targets for RV dysfunction.
Area of Science:
- Pediatric Cardiology
- Echocardiography
- Neonatal Physiology
Background:
- Right ventricular (RV) function is often compromised in infants with pulmonary hypertension (PHT), impacting disease severity.
- Tissue Doppler imaging (TDI) offers a novel echocardiographic method for directly quantifying myocardial velocities and assessing ventricular function in infants.
Purpose of the Study:
- To utilize TDI to measure and compare RV myocardial velocities in infants diagnosed with PHT against healthy controls.
- To investigate potential differences in RV systolic and diastolic function between these groups.
Main Methods:
- A prospective case-control study involving 28 control infants and 15 infants with PHT (including 11 with congenital diaphragmatic hernia - CDH).
- TDI was employed to capture systolic and diastolic myocardial velocities of the RV and interventricular septum in all participants.
Main Results:
- Infants with PHT demonstrated significantly reduced systolic isovolumic contraction velocity (IVV) and systolic ejection velocity (S) compared to controls.
- Early diastolic myocardial velocity (E') was also significantly diminished in the RV of PHT infants.
- Similar reductions in systolic and diastolic TDI velocities were noted in the CDH subgroup.
Conclusions:
- TDI provides a non-invasive means to assess RV myocardial velocities in infants.
- Diminished systolic and diastolic velocities in PHT infants suggest impaired contraction and early diastolic relaxation.
- Therapies targeting inotropic and lusitropic function may be beneficial for PHT infants with RV dysfunction, though further research on load-dependency and treatment effects is needed.
Background:
In infants with pulmonary hypertension (PHT), right ventricular (RV) function may be altered and contribute to disease severity. Tissue Doppler imaging (TDI) is a new echocardiographic modality which directly measures myocardial velocities and may allow quantitative assessment of systolic and diastolic ventricular function in infants.
Objective:
To measure and compare RV myocardial velocities in infants with PHT and in normal control infants, using TDI.
Methods:
This was a prospective case-control study. Twenty-eight control infants and 15 infants with PHT, of whom 11 had congenital diaphragmatic hernia (CDH), were recruited. TDI was used to obtain systolic and diastolic myocardial velocities in the RV and interventricular septum in all infants.
Results:
There were significant reductions in systolic isovolumic contraction velocity (IVV; 5.3 vs. 6.6 cm/s) and systolic ejection velocity (S; 6.6 vs. 9.2 cm/s) in the PHT group compared to the control group. Early diastolic myocardial velocity, E', was also significantly reduced in the RV in the PHT infants compared to controls (-4.3 vs. 8.6 cm/s). The same significant reductions in systolic and early diastolic TDI velocities were observed in the subgroup of CDH infants alone.
Conclusions:
TDI permits non-invasive assessment of RV myocardial velocities in infants. Reduced systolic and diastolic velocities in PHT may represent impaired systolic contraction and early diastolic relaxation. Therapies which target inotropic and lusitropic function may be appropriate in infants with PHT and RV dysfunction. The load-dependency of TDI measures in infants and the effects of specific therapies on RV function in PHT require further investigation.
