Prognostic Value of RV Tissue Annular Velocity in Chronic Pulmonary Artery Hypertension

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic pulmonary artery hypertension (PAH) (n=85). Intervention: Severe pulmonary artery hypertension (PASP >= 70 mmHg) evaluated by PW-TDI and M-mode TAPSE vs. Mild to moderate pulmonary artery hypertension (PASP < 70 mmHg). Primary outcome: Tricuspid annular plane systolic excursion (TAPSE, mm) and lateral tricuspid early diastolic annular velocity (E', cm/sec) (p=0.01).

Q: What does this research mean for the field?

Severe chronic pulmonary artery hypertension is associated with significantly lower TAPSE and right ventricular tissue Doppler early diastolic annular velocities, which correspond with increased right ventricular dysfunction and re-hospitalization. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Prabin Shrivastava; Pravin Jha; Tony Ete; Swapan K. Saha; Rinchin Dorjee Megeji; Gaurav Kavi; Chandra Kumar Das; Shingamlung Kamei; Dhanjit Nath; Synrang Batngen Warjri; Rondeep kumar Nath Sivam; Manish Kapoor; Amit Malviya; Animesh Mishra

doi:10.4236/oalib.1103295

January 1, 2017OALibOpen Access

Prognostic Value of RV Tissue Annular Velocity in Chronic Pulmonary Artery Hypertension

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Key result

Severe PAH (PASP >=70 mmHg) was associated with lower TAPSE (18.13 vs 20.45 mm, p=0.01) and E' lateral velocity (13.33 vs 16.05 cm/sec, p=0.05) compared to mild-to-moderate PAH.

Why the study?

Choosing a non-invasive, widely available, inexpensive, and accurate method to evaluate right ventricular function in chronic pulmonary artery hypertension remained a clinical challenge, and only a limited number of tissue Doppler imaging studies had assessed right ventricular systolic and diastolic function.

Does pulse wave tissue Doppler imaging of tricuspid annular velocities and TAPSE correlate with pulmonary artery systolic pressure, right ventricular function, and re-hospitalization in patients with chronic pulmonary artery hypertension?

Key Points

To assess the prognostic significance of right ventricular tissue Doppler annular velocities and tricuspid annular plane systolic excursion in chronic pulmonary artery hypertension.
Enrolled 85 patients with pulmonary artery hypertension stratified by pulmonary artery systolic pressure into Group A (< 70 mmHg, N = 56) and Group B (≥ 70 mmHg, N = 29).
Assessed echocardiographic indices including tricuspid annular plane systolic excursion (TAPSE) and early diastolic tissue Doppler velocities (E` septal and E` lateral) at baseline and 6 months.
Baseline TAPSE was significantly lower in Group B compared to Group A (18.13 mm vs 20.45 mm, p = 0.01), along with lower E` lateral velocity (13.33 cm/sec vs 16.05 cm/sec, p = 0.05).
At 6-month follow-up, patients with right ventricular dysfunction exhibited significantly lower TAPSE (13 vs 20.6 mm, p < 0.05), E` septal velocity (6.2 vs 12.6 cm/sec, p < 0.05), and E` lateral velocity (8.9 vs 16 cm/sec, p < 0.05).
Patients requiring re-hospitalization demonstrated significantly lower right ventricular tissue Doppler early diastolic annular velocities and TAPSE compared to non-hospitalized patients (p < 0.05).

Study Design

Type

Cohort (n=85)

Multicenter

No

Structured PICO

Does pulse wave tissue Doppler imaging of tricuspid annular velocities and TAPSE correlate with pulmonary artery systolic pressure, right ventricular function, and re-hospitalization in patients with chronic pulmonary artery hypertension?

P

Population

85 patients with confirmed chronic primary or secondary pulmonary artery hypertension in India, 60% female, stratified by pulmonary artery systolic pressure (<70 mmHg vs >=70 mmHg) and followed for 6 months.

E

Exposure

Pulse wave tissue Doppler imaging (PW-TDI) of early diastolic annular velocities (E') at the septal and lateral tricuspid annulus and M-mode tricuspid annular plane systolic excursion (TAPSE) in severe PAH (PASP >=70 mmHg)

C

Comparator

Mild to moderate PAH (PASP <70 mmHg) and patients with normal right ventricular function

O

Outcome

Comparison of right ventricular performance indices (TAPSE in M-mode and TDI early diastolic annular velocity E' at septal and lateral tricuspid annulus) with pulmonary artery systolic pressure (PASP), right ventricular function, and re-hospitalization over 6 months follow-upsurrogate

Main Result

Absolute Event Rate: 18.13% vs 20.45%

p-value: p=0.01

Echocardiographic TAPSE and tricuspid annular early diastolic tissue Doppler velocities (E') inversely correlate with pulmonary artery systolic pressure and identify chronic PAH patients at higher risk of RV dysfunction and re-hospitalization.

Limitations

Lack of a healthy control group
Patients were enrolled from the same ethnic background
Short duration of follow-up (6 months) in contrast to the natural history of secondary pulmonary hypertension
Inclusion of subjective functional class assessment
Cardiac catheterization or cardiac magnetic resonance imaging (CMR) were not performed to correlate with Doppler tissue imaging variables
Lack of healthy control group
Patients enrolled from the same ethnic background
Short duration of follow-up (6 months) relative to the natural history of secondary pulmonary hypertension
Inclusion of subjective functional class
No cardiac catheterization or cardiac MRI performed to correlate with Doppler tissue imaging variables

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Implication

May aid RV stratification in severe PAH; extends correlations but leaves open prognostic utility and requires validation.

Abstract

Background: Elevated afterload in chronic pulmonary artery hypertension (PAH) leads to sequence of events resulting in right ventricular (RV) hypertrophy, dilatation and eventual RV dysfunction. In last two decades, great emphasis has been laid on the ri...

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Cite This Study

Shrivastava et al. (2017) conducted a cohort in Chronic pulmonary artery hypertension (PAH) (n=85). Severe pulmonary artery hypertension (PASP >= 70 mmHg) evaluated by PW-TDI and M-mode TAPSE vs. Mild to moderate pulmonary artery hypertension (PASP < 70 mmHg) was evaluated on Tricuspid annular plane systolic excursion (TAPSE, mm) and lateral tricuspid early diastolic annular velocity (E', cm/sec) (p=0.01). Severe PAH (PASP >=70 mmHg) was associated with lower TAPSE (18.13 vs 20.45 mm, p=0.01) and E' lateral velocity (13.33 vs 16.05 cm/sec, p=0.05) compared to mild-to-moderate PAH.

synapsesocial.com/papers/6a7e060caf21e1248e3ca627 https://doi.org/10.4236/oalib.1103295

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Prognostic Value of RV Tissue Annular Velocity in Chronic Pulmonary Artery Hypertension

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prognostic Value of RV Tissue Annular Velocity in Chronic Pulmonary Artery Hypertension

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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