Tissue Doppler Imaging of Right Ventricular Decompensation in Pulmonary Hypertension

Right ventricular (RV) function is closely linked to outcomes in pulmonary hypertension (PH). The authors sought to evaluate RV myocardial strain in 3 groups of patients: normal, PH with compensated RV function (PH-C), and PH with decompensated RV function (PH-D). Fifty-six patients (aged 56±12 years; 40 women; mean pulmonary artery pressure [MPAP] range, 13–82 mm Hg) underwent right heart catheterization and 2-dimensional echocardiography with tissue Doppler imaging of the RV. Right atrial pressures were 6±3, 5±2, and 14±4 mm Hg; MPAP values were 19±3, 44±15, and 56±13 mm Hg; pulmonary vascular resistances were 1.4±0.4, 7.9±5.1, and 11.5±6.6 Wood units; and cardiac indices were 3.4±0.9, 2.8±0.8, and 2.2±0.7 L/min/m2 (P<.05 for all for normal, PH-C, and PH-D patients), respectively. RV free wall strain decreased significantly among all 3 groups (−26%±6%, −19%±7%, and −14%±5%; P<.0001). RV free wall strain decreases in PH without hemodynamically decompensated RV function suggesting it may be a preceding step in the development of RV failure. This may be of particular use in following patients sequentially.