USE OF TISSUE DOPPLER IMAGING TO DETECT RIGHT VENTRICULAR MYOCARDIAL DYSFUNCTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Jyothi Samanth; Padmakumar R; Ashwinikumar Mohapatra; Krishnananda N; Navin Patil; Kartthik Rao; Vidya Nayak; Balaji Ommurugan; Dipanjan Bhattachariya; Rahul Kotian

doi:10.22159/ajpcr.2017.v10i6.17517

Authors

Jyothi Samanth Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University, Karnataka, India.
Padmakumar R Department of Cardiology, KMC Manipal, Manipal University, Manipal, Karnataka, India.
Ashwinikumar Mohapatra 3Department of Pulmonary Medicine, KMC Manipal, Manipal University, Manipal, Karnataka, India.
Krishnananda N Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University, Karnataka, India.
Navin Patil Department of Pharmacology, KMC Manipal, Manipal University, Manipal, Karnataka, India.
Kartthik Rao Department of Medicine, KMC Manipal, Manipal University, Manipal, Karnataka, India.
Vidya Nayak Department of Cardiovascular Technology, School of Allied Health Sciences, Manipal University, Karnataka, India.
Balaji Ommurugan Department of Pharmacology, KMC Manipal, Manipal University, Manipal, Karnataka, India.
Dipanjan Bhattachariya Department of Pharmacology, KMC Manipal, Manipal University, Manipal, Karnataka, India.
Rahul Kotian Department of Medical Imaging Technology, SOAHS, Manipal University, Manipal, Karnataka, India.

DOI:

https://doi.org/10.22159/ajpcr.2017.v10i6.17517

Keywords:

Strain rate, Tissue annular velocity, Doppler, Right ventricle geometry, Case-control

Abstract

Objective: To determine the utility of tissue Doppler imaging (TDI) in detecting early right ventricle (RV) myocardial dysfunction, given its prognostic implications in patients with chronic obstructive pulmonary disease (COPD).

Methods: Â A prospective case-control study was carried out involving 36 COPD patients in an acute exacerbated state as cases and 34 healthy subjects serving as controls. Each subject underwent a baseline echocardiography using various methods ranging from m-mode and 2-dimensional measures for analyzing RV geometry to strain and strain rate using Tissue Doppler Imaging to measure RV deformation. The cases underwent a subsequent echocardiogram 1month later once the respiratory symptoms subsided.

Results: A significant difference was observed in RV tissue annular velocities ( E', A', S) between cases and the controls at baseline. However no significant increase was observed in tissue annular velocities among cases during remission states from baseline. Peak systolic strain in COPD group was significantly reduced in comparison to controls, but not significantly increased during remission when compared to baseline in cases. FEV1/VC did not bear any significant correlation with RV strain. Tei index had a negative linear correlation with peak systolic strain of RV, which was statistically significant.

Conclusion: TDI parameters revealed that RV dysfunction remains unaltered even in remission state of COPD, despite pulmonary arterial pressure normalizing. In light of it bearing a negative prognosis in COPD, RV dysfunction merits assessment in COPD patients, both in acute exacerbations as well as in remission.

Â

Downloads

Download data is not yet available.

References

Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997;349(9603):1436-42.

Murray CJ, Lopez AD. Regional patterns of disability-free life expectancy and disability-adjusted life expectancy: Global burden of disease study. Lancet 1997;349(9062):1347-52.

Bolton CE, Ionescu AA, Shiels KM, Pettit RJ, Edwards PH, Stone MD, et al. Associated loss of fat-free mass and bone mineral density in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004;170(12):1286-93.

Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc 2005;2(1):8-11.

Sin DD, Wu L, Man SF. The relationship between reduced lung function and cardiovascular mortality: A population-based study and a systematic review of the literature. Chest 2005;127(6):1952-9.

Weitzenblum E. Chronic cor pulmonale. Heart 2003;89(2):225-30.

Curkendall SM, DeLuise C, Jones JK, Lanes S, Stang MR, Goehring E Jr, et al. Cardiovascular disease in patients with chronic obstructive pulmonary disease, Saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol 2006;16(1):63-70.

Rutten FH, Cramer MJ, Grobbee DE, Sachs AP, Kirkels JH, Lammers JW, et al. Unrecognized heart failure in elderly patients with stable chronic obstructive pulmonary disease. Eur Heart J 2005;26(18):1887-94.

Weber T, Auer J, Oâ€™Rourke MF, Kvas E, Lassnig E, Lamm G, et al. Increased arterial wave reflections predict severe cardiovascular events in patients undergoing percutaneous coronary interventions. Eur Heart J 2005;26(24):2657-63.

Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, et al. Arterial stiffness and risk of coronary heart disease and stroke: The Rotterdam study. Circulation 2006;113(5):657-63.

Sabit R, Bolton CE, Edwards PH, Pettit RJ, Evans WD, McEniery CM, et al. Arterial stiffness and osteoporosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007;175(12):1259-65.

Vitarelli A, Conde Y, Cimino E, Stellato S, Dâ€™Orazio S, Dâ€™Angeli I, et al. Assessment of right ventricular function by strain rate imaging in chronic obstructive pulmonary disease. Eur Respir J 2006;27(2):268-75.

LÃ³pez-Candales A, Rajagopalan N, Dohi K, Gulyasy B, Edelman K, Bazaz R. Abnormal right ventricular myocardial strain generation in mild pulmonary hypertension. Echocardiography 2007;24(6):615-22.

Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007;176(6):532-55.

Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA. Age- and gender-related ventricular-vascular stiffening: A community-based study. Circulation 2005;112(5):2254-62.

Sutton-Tyrrell K, Najjar SS, Boudreau RM, Venkitachalam L, Kupelian V, Simonsick EM, et al. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation 2005;111(25):3384-90.

Fernandes VR, Polak JF, Cheng S, Rosen BD, Carvalho B, Nasir K, et al. Arterial stiffness is associated with regional ventricular systolic and diastolic dysfunction: The multi-ethnic study of atherosclerosis. Arterioscler Thromb Vasc Biol 2008;28(1):194-201.

Mottram PM, Haluska BA, Leano R, Carlier S, Case C, Marwick TH. Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease. Heart 2005;91(12):1551-6.

Hundley WG, Kitzman DW, Morgan TM, Hamilton CA, Darty SN, Stewart KP, et al. Cardiac cycle-dependent changes in aortic area and distensibility are reduced in older patients with isolated diastolic heart failure and correlate with exercise intolerance. J Am Coll Cardiol 2001;38(3):796-802.

France AJ, Prescott RJ, Biernacki W, Muir AL, MacNee W. Does right ventricular function predict survival in patients with chronic obstructive lung disease? Thorax 1988;43:621-6.

Burgess MI, Mogulkoc N, Bright-Thomas RJ, Bishop P, Egan JJ, Ray SG. Comparison of echocardiographic markers of right ventricular function in determining prognosis in chronic pulmonary disease. J Am Soc Echocardiogr 2002;15:633-9.

Vestbo J, Hurd SS, AgustÃ AG, Jones PW, Vogelmeier C, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013;187(4):347-65.

Terzano C, Romani S, Paone G, Conti V, Oriolo F. COPD and thyroid dysfunctions. Lung 2014;192(1):103-9.

Schenk P, Globits S, Koller J, Brunner C, Artemiou O, Klepetko W, et al. Accuracy of echocardiographic right ventricular parameters in patients with different end-stage lung diseases prior to lung transplantation. J Heart Lung Transplant 2000;19(2):145-54.

Bommer W, Weinert L, Neumann A, Neef J, Mason DT, DeMaria A. Determination of right atrial and right ventricular size by two-dimensional echocardiography. Circulation 1979;60:91-100.

Kukulski T, HÃ¼bbert L, Arnold M, Wranne B, Hatle L, Sutherland GR. Normal regional right ventricular function and its change with age: A Doppler myocardial imaging study. J Am Soc Echocardiogr 2000;13(3):194-204.

Weidemann F, Eyskens B, Jamal F, Mertens L, Kowalski M, Dâ€™Hooge J, et al. Quantification of regional left and right ventricular radial and longitudinal function in healthy children using ultrasound-based strainrate and strain imaging. J Am Soc Echocardiogr 2002;15(1):20-8.

Dambrauskaite V, Herbots L, Claus P, Verleden G, Van Raemdonck D, Delcroix M, et al. Differential changes in regional right ventricular function before and after a bilateral lung transplantation: An ultrasonic strain and strain rate study. J Am Soc Echocardiogr 2003;16(5):432-6.

Hilde JM, SkjÃ¸rten I, GrÃ¸tta OJ, Hansteen V, Melsom MN, Hisdal J, et al. Right ventricular dysfunction and remodeling in chronic obstructive pulmonary disease without pulmonary hypertension. J Am Coll Cardiol 2013;62(12):1103-11.