Key result
RVOT to LVOT ejection duration ratio <0.99 identifies abnormal PASP with ~0.96 AUC.
Why the study?
Mechanical dyssynchrony in chronic pulmonary hypertension was previously identified only through myocardial tissue Doppler imaging, and whether pulsed Doppler during routine echocardiography could detect interventricular ejection differences was untested.
Observational (n=70)
May offer simple echo marker of RV-LV dyssynchrony in cPH; leaves open clinical utility pending validation.
BACKGROUND: Chronic pulmonary hypertension (cPH) is known to delay maximal right ventricular (RV) deformation, causing mechanical dyssynchrony, which previously has been identified only through the use of myocardial tissue Doppler imaging. However, alterations between RV and left ventricular (LV) ejection should be easily identified during routine echocardiographic examinations. HYPOTHESIS: We hypothesized that assessment of differences in ejection fraction between left and right ventricles would be detected using pulsed Doppler. METHODS: Standard echo and Doppler data were collected from 30 patients without PH (mean age, 53 ± 7 y; mean pulmonary artery systolic pressure [PASP], 31 ± 5 mm Hg) and from 40 patients with cPH (mean age, 53 ± 13 y, P not significant; mean PASP, 82 ± 24 mm Hg, P<0.00001). Temporal differences in the ejection of both ventricles were measured as the ratio of total duration of RV to LV outflow tract (RVOT and LVOT) pulsed Doppler signals. RESULTS: A ratio (<0.99) of RVOT to LVOT total duration of ejection was found not only to be the best Doppler parameter to identify an abnormal pulmonary artery systolic pressure, with a 90% sensitivity and 100% specificity (area under the curve 0.958, P = 0.0001), but also identified differences in the temporal ejection between the 2 ventricles, or dyssynchrony, as a result of cPH. CONCLUSIONS: The ratio of pulsed Doppler RV to LV total duration of ejection is easily obtainable and appears useful in identifying the presence of interventricular dyssynchrony in cPH patients. A prospective study is now required to determine if this Doppler ratio can identify minute changes in the ejection of both ventricles as a result of changes in disease status or response to PH therapy.
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López‐Candales et al. (2011) conducted an observational in Chronic pulmonary hypertension and interventricular dyssynchrony (n=70). Pulsed Doppler ratio of right to left ventricular outflow tract (RVOT to LVOT) total duration of ejection vs. Patients without pulmonary hypertension was evaluated on Identification of abnormal pulmonary artery systolic pressure and interventricular dyssynchrony using an RVOT to LVOT ejection duration ratio <0.99 (AUC 0.958, p=0.0001). An RVOT to LVOT pulsed Doppler ejection duration ratio <0.99 identified abnormal pulmonary artery systolic pressure with 90% sensitivity and 100% specificity (AUC 0.958, P=0.0001).
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