Early diagnosis of right ventricular systolic dysfunction by tissue doppler-derived isovolumic myocardial acceleration in patients with chronic obstructive pulmonary disease

Abstract

Objectives: The aim of the study was to assess validity of tissue Doppler imaging (TDI)-derived right ventricular (RV) myocardial systolic velocities in early detection of RV systolic dysfunction in chronic obstructive pulmonary disease (COPD). Methods: Ninety COPD patients (50 pure COPD and 40 with right heart failure [RHF]) and 40 controls were enrolled. Respiratory function tests, conventional echocardiographic parameters, and TDI-derived isovolumic myocardial acceleration (IVA), peak myocardial velocity during isovolumic contraction (IVV), peak velocity during systolic ejection (Sa) were measured. Results: All the TDI-derived RV systolic velocities were impaired in COPD (P = 0.0001) compared to controls. IVA was the only parameter that could distinguish the patients with pure COPD and COPD with RHF (P = 0.0001). IVA was found to be significantly correlated with FEV1 (r = 0.41, P = 0.0001), FEV1/FVC (r = 0.43, P = 0.0001), pulmonary artery pressure (r = -0.34, P = 0.001), pulmonary flow acceleration time (r = 0.48, P = 0.0001), and tricuspid annular systolic excursion (r = -0.41, P = 0.0001). In addition, IVA ≤ 2.7 m/sec2 was able to predict COPD patients from controls with 81% sensitivity, 98% specificity and IVA ≤ 1.9 m/sec2 predicted COPD patients accompanied by RHF with 82% sensitivity, 77% specificity from patients without RHF. Conclusions: TDI-derived RV IVA is a novel, noninvasive echocardiographic index which may be used in the assessment of subclinical RV dysfunction in patients with COPD. (ECHOCARDIOGRAPHY, Volume 26, October 2009).