Right ventricular free wall motion abnormalities as a simple method of assessment in patients with pulmonary hypertension (RCD code: II 1A.O)

Background : Pulmonary hypertension (PH) is a cardiovascular pathology leading to right-sided heart failure. A qualitative assessment of right ventricular (RV) function in echocardiography provides valuable information on a patient’s condition. The standard echocar- diographic parameter, assessed in PH patients, is RV free wall motion. Aim : To verify the utility of RV free wall motion assessment via echocardiography in PH patients. Methods : Data from 30 PH patients, regardless of aetiology (except for left heart disease), was retrospectively analyzed. Based on the RV free wall motion visual echocardiographic assessment the population was divided into: group 1- normokinetic; group 2- hypokinetic RV. All patients underwent a medical interview, physical examination, basic laboratory work-up, echocardiography, and right heart catheterization (RHC). Twenty-one patients underwent a cardiopulmonary exercise test (CPET). Results : The analysis revealed, that patients with RV free wall hypokinesis were characterized by impaired gas exchange parameters (higher values of ventilatory equivalents for oxygen and carbon dioxide, higher end-tidal oxygen pressures, lower end-tidal carbon dioxide pres- sures and higher minute ventilation – carbon dioxide production relation slope) and cardiovascular response to exercise (lower increase in O2 pulse during exercise) obtained in the CPET. RHC showed that patients with hypokinetic RV had higher diastolic and mean pul- monary artery pressures (dPAP, mPAP), lower cardiac index, and higher pulmonary vascular resistance. Conclusions : RV free wall motion abnormalities, assessed using echocardiography in PH patients, are found in those with more advanced disease. They are characterized by impaired ventilation in the CPET and more advanced haemodynamic abnormalities in RHC. The association between this parameter and prognosis requires validation in a larger population of patients. JRCD 2017; 3 (5): 161–167