Analysis of Regional Right Ventricular Function by Tissue Doppler Imaging in Patients with Aortic Stenosis

Right ventricular (RV) dysfunction is frequently observed in patients with aortic stenosis (AS). Nevertheless, assessment of regional RV deformation is yet not performed. The aim of the study was to analyze the impact of moderate and severe AS on global and regional RV function by a multisegmental approach using tissue Doppler imaging (TDI).

In 50 patients (Group I - AS [n = 25] and Group II - normal controls [n = 25]), additional echocardiographic views of the RV were prospectively performed. The TDI sample volume was placed in the basal myocardial region of the anterior (RV-anterior), inferior (RV-inferior), and free RV wall (RV-free wall) to assess the following parameters: S'_RV, E'_RV, and A'_RV waves; IVCT_RV; IVRT_RV; and myocardial performance index (MPI_RV).

In AS patients, left ventricular (LV) mass index, left atrial (LA) volume index, and LV end-diastolic pressure were significantly increased. Moreover, AS patients had higher systolic pulmonary artery pressure (sPAP) and lower values for PV AccT (P < 0.0001), but TAPSE was not different between the two groups (P = 0.062). In AS patients, IVRT_RV-anterior, IVRT_RV-inferior, and IVRT_{RV-free wall} and MPI_RV were statistically increased (P < 0.0001). A significant correlation between IVRT_RV (evaluated at all three regions) and the parameters including sPAP, PV AccT, and E_LV/e'_LV ratio was observed in AS. A strong correlation was observed between IVRT_{RV-free wall/inferior} and AS severity by evaluation of velocities, gradient, and aortic valve area (P < 0.0001).

The present study reports a correlation between the severity of AS and the increase of IVRT_RV and MPI_RV. Thus, a distinct analysis of RV performance is important for echocardiographic evaluation of patients with AS.