Relation of Right Ventricular Free Wall Mechanical Delay to Right Ventricular Dysfunction as Determined by Tissue Doppler Imaging

Several well-established echocardiographic parameters used in the assessment of right ventricular (RV) performance, as well as tissue Doppler imaging (TDI) to investigate RV free wall mechanical events, were prospectively obtained from a heterogenous group of 20 patients with varying degrees of pulmonary hypertension (mean age 51 ± 13 years; World Health Organization class average 2.8, mean pulmonary systolic pressure 78 ± 24 mm Hg) and compared with similar data retrospectively obtained from 20 healthy volunteers (mean age 45 ± 15 years). Patients with varying degrees of pulmonary hypertension had worse RV performance parameters than healthy volunteers (RV fractional area change 37 ± 13% vs 52 ± 5%, p < 0.0001; RV myocardial performance index 0.76 ± 0.31 vs 0.29 ± 0.11, p < 0.0001; and eccentricity index 1.41 ± 0.57 vs 0.98 ± 0.06, p < 0.005). Similarly, in these patients with abnormal RV performance, TDI showed statistically significant smaller peak longitudinal RV free wall strain (−21.5 ± 9.0% vs −28.0 ± 4.1%, p < 0.01) and significantly delayed time to peak strain (459 ± 76 vs 388 ± 29 ms, p < 0.0005) values than in healthy volunteers; a very strong correlation between RV mechanical delay and RV fractional area change (r = −0.89) was noted.