Circulation. 2000;101:e117
(Circulation. 2000;101:e117.)
© 2000 American Heart Association, Inc.
Circulation Electronic Pages |
Doppler Echocardiographic Index of Global Right Ventricular Function
Malcolm I. Burgess, MRCP;
Simon Ray, FRCP, MD, FACC
Northwest Regional Cardiac Centre,
Wythenshawe Hospital,
Manchester, United Kingdom
Nesrin Mogulkoc, MD;
Jim Egan, MRCP, MD
Northwest Lung Centre,
Wythenshawe Hospital,
Manchester, United Kingdom
 |
Introduction
|
|---|
To the Editor:
In pulmonary disease, right ventricular
dysfunction has an important bearing on prognosis.1
Incalzi et al2 recently demonstrated the prognostic
implications of electrocardiographic signs of chronic cor pulmonale in
patients with chronic obstructive pulmonary disease. Two
electrocardiographic features in particular, an
S1S2S3
pattern and a P-wave axis of >90°, suggesting right atrial overload,
predicted mortality over 13 years of follow-up. This well-conducted
study illustrates the importance of an inexpensive
diagnostic technique in risk stratification and is of
particular value since the clinical signs of cor pulmonale are too
insensitive for routine clinical application. It has been preceded by a
wealth of work highlighting the considerable effort that has gone into
the identification of a prognostic marker that is widely applicable,
noninvasive, and easily interpretable and repeatable.
Of note, the authors indicate the failings of
echocardiographic evaluation of the right heart in this
setting. They refer to the technical difficulties of
transthoracic studies in patients with lung hyperinflation
and to the high error when pulmonary artery pressure is
estimated based on a tricuspid regurgitant jet, which is present in
only a minority of patients. Tei et al3 recently described
a Doppler echocardiographic index of global right
ventricular function based on tricuspid and
pulmonary flow dynamics. Assessment of right
ventricular function has been confounded by the
asymmetrical geometry of the chamber, but since this index is derived
from pulsed-wave Doppler measurements, evaluation can be made
independently of 2-D imaging, a further advantage given poor patient
echogenicity. The index is reproducible and not affected by heart rate
or the severity of tricuspid regurgitation. Among a
variety of clinical and echocardiographic
variables, the index was the most powerful predictor of prognosis
in a study of patients with primary pulmonary
hypertension.4 We have calculated the index in patients
with interstitial5 and a wide range of other
pulmonary conditions, including chronic obstructive
pulmonary disease, without any technical difficulties. A useful
inverse correlation exists between the index and arterial
oxygen tension, and it is both a sensitive and specific indicator of
the presence of pulmonary arterial
hypertension.
Like the authors, we strongly advocate the use of noninvasive
indicators of right ventricular performance in
patients with pulmonary disease as a means of identifying those
at high risk. This new echocardiographic technique,
which can be incorporated into a conventional transthoracic
study, may be more practical for this purpose.
|
References
|
|---|
-
Traver GA, Cline MG, Burrows B. Predictors of
mortality in chronic obstructive pulmonary disease: a 15 year
follow-up study. Am Rev Respir Dis. 1979;119:895–902.[Medline]
[Order article via Infotrieve]
-
Incalzi RA, Fuso L, De Rosa M, Di Napoli A, Basso S,
Pagliari G, Pistelli R. Electrocardiographic signs of chronic cor
pulmonale: a negative prognostic finding in chronic obstructive
pulmonary disease. Circulation. 1999;99:1600–1605.[Abstract/Free Full Text]
-
Tei C, Dujardin KS, Hodge DO, Bailey KR, McGoon MD,
Tajik AJ, Seward JB. Doppler echocardiographic
index for assessment of global right ventricular function.
J Am Soc Echocardiogr. 1996;9:838–847.[Medline]
[Order article via Infotrieve]
-
Yeo TC, Dujardin KS, Tei C, Mahoney DW, McGoon MD,
Seward JB. Value of a Doppler-derived index combining
systolic and diastolic time intervals in predicting
outcome in primary pulmonary hypertension. Am J
Cardiol. 1998;81:1157–1161.[Medline]
[Order article via Infotrieve]
-
Burgess MI, Haider Y, Lok S, Egan JJ, Ray SG. A simple
echocardiographic index of global right ventricular function in
patients with idiopathic pulmonary fibrosis. Am Rev Respir
Dis. 1999;159:A51.
Abstract.
Response
Raffaele Antonelli Incalzi, MD;
Leonello Fuso, MD;
Marino De Rosa, MD;
Anteo Di Napoli, MD;
Salvatore Basso, MD;
Gabriella Pagliari, MD;
Riccardo Pistelli, MD
Respiratory Physiology Department,
Catholic University,
Rome, Italy
|
Introduction
|
|---|
We have read with great interest the letter by Dr Burgess and
colleagues.
The proposed method of assessing right
ventricular function
looks quite promising, especially
because of its alleged applicability
in various clinical and
hemodynamic conditions. The authors
demonstrated that
this index is easily measurable both in chronic
obstructive
pulmonary disease (COPD) and in interstitial lung
disease
and qualifies as a reliable indirect measure of
pulmonary hypertension.
R1 However, the available
evidence supports its role as a prognostic
tool only in primary
pulmonary hypertension, which is a relatively
uncommon
condition.
R2 Thus, we think that efforts should be
made to
verify whether this index carries autonomous prognostic
implications in
COPD as well as in pulmonary hypertension complicating
congestive
heart failure. Eventually, the response of this index to
acute
changes in pulmonary artery pressure should be assessed
to clarify
its predictive power.
|
References
|
|---|
-
Burgess MI, Haider Y, Lok S, Egan JJ, Ray SG. A
simple echocardiographic index of global right ventricular function in
patients with idiopathic pulmonary fibrosis. Am Rev Respir
Dis. 1999;159:A51. Abstract.
-
Yeo TC, Dujardin KS, Tei C, Mahoney DW, McGoon MD,
Seward JB. Value of a Doppler-derived index combining
systolic and diastolic time intervals in predicting
outcome in primary pulmonary hypertension. Am J
Cardiol. 1998;81:1157–1161.
Top
Introduction
References