Document Detail


Utility of right ventricular Tei index in the noninvasive evaluation of chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy.
MedLine Citation:
PMID:  19356547     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We evaluated the utility of tissue Doppler-derived right ventricular (RV) Tei (or myocardial performance) index in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after pulmonary thromboendarterectomy (PTE) and assessed correlations with mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), and cardiac output (CO). BACKGROUND: The assessment of RV function is limited with 2-dimensional echocardiography. The RV Tei index, an indicator of RV myocardial performance, is derived by Doppler measurements and is unaffected by RV geometry. The use of tissue Doppler imaging (at the lateral tricuspid annulus) for RV Tei index calculation is simple and eliminates the need for pulsed-wave Doppler recordings of both RV inflow and outflow. METHODS: Ninety-three patients with CTEPH were prospectively studied along with 13 control patients. Right ventricular tissue Doppler imaging and right heart catheterization were performed before and after PTE. Right ventricular Tei index was compared with values of mPAP, PVR, and CO with the use of linear regression. RESULTS: Right ventricular Tei index was 0.52 +/- 0.19 in patients with CTEPH and 0.27 +/- 0.09 in control patients (p < 0.0001). After PTE, RV Tei index decreased to 0.33 +/- 0.10 (p < 0.0001). Pulmonary vascular resistance correlated well with RV Tei index before (r = 0.78, p < 0.0001) and after (r = 0.67, p < 0.0001) surgery. Also, the absolute change in Tei index in each patient after PTE correlated well with the concomitant change in PVR (r = 0.75, p < 0.0001). RV Tei index did not correlate as well with mPAP (pre-operatively: r = 0.55, p < 0.0001; post-operatively: r = 0.26, p = 0.03) or CO (pre-operatively: r = 0.57, p < 0.0001; post-operatively: r = 0.43, p < 0.0001). CONCLUSIONS: These results demonstrate a correlation between RV Tei index and right heart hemodynamics (particularly PVR) in CTEPH. Because PVR is difficult to estimate noninvasively -- and yet correlates with disease severity -- the RV Tei index may be a valuable noninvasive parameter for monitoring disease severity in CTEPH and outcome after PTE.
Authors:
Daniel G Blanchard; Philip J Malouf; Swaminatha V Gurudevan; William R Auger; Michael M Madani; Patricia Thistlethwaite; Thomas J Waltman; Lori B Daniels; Ajit B Raisinghani; Anthony N DeMaria
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  2     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-04-09     Completed Date:  2009-07-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  143-9     Citation Subset:  IM    
Affiliation:
Division of Cardiology, University of California San Diego School of Medicine and UCSD Medical Center San Diego, La Jolla, CA 92037, USA. dblanchard@ucsd.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Blood Pressure
Cardiac Output
Chronic Disease
Echocardiography, Doppler*
Endarterectomy*
Female
Heart Catheterization*
Hemodynamics*
Humans
Hypertension, Pulmonary / etiology,  physiopathology,  surgery,  ultrasonography*
Image Interpretation, Computer-Assisted
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Pulmonary Artery / physiopathology*,  surgery
Thromboembolism / complications*,  physiopathology,  surgery,  ultrasonography
Treatment Outcome
Vascular Resistance
Ventricular Function, Right*
Young Adult
Comments/Corrections
Comment In:
JACC Cardiovasc Imaging. 2009 Feb;2(2):150-2   [PMID:  19356548 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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