Efficacy of Isovolumic Acceleration in Assessing Right Ventricular Function in Pulmonary Hypertension

V. S. Bharathi, Adikesava Naidu Otikunta, Y. V. Subbareddy, K. Laxman Rao, Syed Imamuddin, Ashok Thakkar

Department of Cardiology, Osmania General Hospital, Hyderabad, India.
Department of Clinical Trials, Sahajanand Medical Technologies Pvt. Ltd., Surat, India.

DOI: 10.4236/ijcm.2014.512093                

Abstract

Objective: The aim of the study was to determine usefulness of isovolumic acceleration to assess right ventricular function in patients with pulmonary hypertension. Background: Right ventricular dysfunction is a powerful predictor of adverse outcomes in patients with pulmonary hypertension. Although isovolumic acceleration is a sensitive and relatively load-independent parameter for ventricular contractile function, it has not been widely used. So, the aim of the study was to determine the usefulness of isovolumic acceleration in assessing right ventricular function in patients with pulmonary hypertension. Methods: A single center, prospective observational case-control study has been carried out for the period of one year at Osmania general hospital (Hyderabad). A total of 32 consecutive patients with pulmonary hypertension and 32 age matched healthy controls were recruited in the study as per the inclusion and exclusion criteria of the study. Receiver operator characteristic curves were used to study sensitivity, specificity, positive predictive value, negative predictive values as well as pearson’s correlation coefficients. Results: The results of the study showed that isovolumic acceleration has good significant correlation with right ventricular fractional area change (r = 0.554, p = 0.001) and tissue Doppler myocardial performance index (r = -0.599, p = 0.001) whereas a lesser but significant correlation was observed with tricuspid annular plane systolic excursion (r = 0.327, p = 0.034). Isovolumic acceleration showed higher specificity (81%) and positive predictive value (88%) in diagnosing right ventricular dysfunction in pulmonary hypertension compared to tricuspid annular systolic excursion velocity and tissue Doppler myocardial performance index parameters. Therefore isovolumic acceleration may be a better variable for diagnosing right ventricular dysfunction. Conclusions: Isovolumic acceleration is a sensitive and specific marker of right ventricular function in pulmonary hypertension.

Keywords

Pulmonary Hypertension, Isovolumic Acceleration, Right Ventricular Dysfunction

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Chin, K.M., Kim, N.H. and Rubin, L.J. (2005) The Right Ventricle in Pulmonary Hypertension. Coronary Artery Disease, 16, 13-18. http://dx.doi.org/10.1097/00019501-200502000-00003
[2]	Galie, N., Hoeper, M.M., Humbert, M., Torbicki, A., Vachiery, J.L., Barbera, J.A., Beghetti, M., Corris, P., Gaine, S., Gibbs, J.S., Gomez-Sanchez, M.A., Jondeau, G., Klepetko, W., Opitz, C., Peacock, A., Rubin, L., Zellweger, M. and Simonneau, G. (2009) Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension: The Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (Esc) and the European Respiratory Society (Ers), Endorsed by the International Society of Heart and Lung Transplantation (Ishlt). European Heart Journal, 30, 2493-2537. http://dx.doi.org/10.1093/eurheartj/ehp297
[3]	Vogel, M., Schmidt, M.R., Kristiansen, S.B., Cheung, M., White, P.A., Sorensen, K. and Redington, A.N. (2002) Validation of Myocardial Acceleration During Isovolumic Contraction as a Novel Noninvasive Index of Right Ventricular Contractility: Comparison with Ventricular Pressure-Volume Relations in an Animal Model. Circulation, 105, 1693-1699. http://dx.doi.org/10.1161/01.CIR.0000013773.67850.BA
[4]	Vogel, M., Derrick, G., White, P.A., Cullen, S., Aichner, H., Deanfield, J. and Redington, A.N. (2004) Systemic Ventricular Function in Patients with Transposition of the Great Arteries after Atrial Repair: A Tissue Doppler and Conductance Catheter Study. Journal of the American College of Cardiology, 43, 100-106. http://dx.doi.org/10.1016/j.jacc.2003.06.018
[5]	Vogel, M., Cheung, M.M., Li, J., Kristiansen, S.B., Schmidt, M.R., White, P.A., Sorensen, K. and Redington, A.N. (2003) Noninvasive Assessment of Left Ventricular Force-Frequency Relationships Using Tissue Doppler-Derived Isovolumic Acceleration: Validation in an Animal Model. Circulation, 107, 1647-1652. http://dx.doi.org/10.1161/01.CIR.0000058171.62847.90
[6]	Schattke, S., Knebel, F., Grohmann, A., Dreger, H., Kmezik, F., Riemekasten, G., Baumann, G. and Borges, A.C. (2010) Early Right Ventricular Systolic Dysfunction in Patients with Systemic Sclerosis without Pulmonary Hypertension: A Doppler Tissue and Speckle Tracking Echocardiography Study. Cardiovascular Ultrasound, 8, 3. http://dx.doi.org/10.1186/1476-7120-8-3
[7]	Voelkel, N.F., Quaife, R.A., Leinwand, L.A., Barst, R.J., McGoon, M.D., Meldrum, D.R., Dupuis, J., Long, C.S., Rubin, L.J., Smart, F.W., Suzuki, Y.J., Gladwin, M., Denholm, E.M. and Gail, D.B. (2006) Right Ventricular Function and Failure: Report of a National Heart, Lung, and Blood Institute Working Group on Cellular and Molecular Mechanisms of Right Heart Failure. Circulation, 114, 1883-1891. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.632208
[8]	D’Alonzo, G.E., Barst, R.J., Ayres, S.M., Bergofsky, E.H., Brundage, B.H., Detre, K.M., Fishman, A.P., Goldring, R.M., Groves, B.M., Kernis, J.T. and et al. (1991) Survival in Patients with Primary Pulmonary Hypertension. Results from a National Prospective Registry. Annals of Internal Medicine, 115, 343-349. http://dx.doi.org/10.7326/0003-4819-115-5-343
[9]	McLaughlin, V.V., Sitbon, O., Badesch, D.B., Barst, R.J., Black, C., Galie, N., Rainisio, M., Simonneau, G. and Rubin, L.J. (2005) Survival with First-Line Bosentan in Patients with Primary Pulmonary Hypertension. The European Respiratory Journal, 25, 244-249. http://dx.doi.org/10.1183/09031936.05.00054804
[10]	Sandoval, J., Bauerle, O., Palomar, A., Gomez, A., Martinez-Guerra, M.L., Beltran, M. and Guerrero, M.L. (1994) Survival in Primary Pulmonary Hypertension. Validation of a Prognostic Equation. Circulation, 89, 1733-1744. http://dx.doi.org/10.1161/01.CIR.89.4.1733
[11]	Rudski, L.G., Lai, W.W., Afilalo, J., Hua, L., Handschumacher, M.D., Chandrasekaran, K., Solomon, S.D., Louie, E.K. and Schiller, N. B. (2010) Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography Endorsed by the European Association of Echocardiography, a Registered Branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography, 23, 685-713. http://dx.doi.org/10.1016/j.echo.2010.05.010
[12]	Toyono, M., Harada, K., Tamura, M., Yamamoto, F. and Takada, G. (2004) Myocardial Acceleration During Isovolumic Contraction as a New Index of Right Ventricular Contractile Function and Its Relation to Pulmonary Regurgitation in Patients after Repair of Tetralogy of Fallot. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography, 17, 332-337. http://dx.doi.org/10.1016/j.echo.2003.12.022
[13]	Arnold, R., Gorenflo, M., Bottler, P., Eichhorn, J., Jung, C. and Goebel, B. (2008) Tissue Doppler Derived Isovolumic Acceleration in Patients after Atrial Repair for Dextrotransposition of the Great Arteries. Echocardiography (Mount Kisco, N.Y.), 25, 732-738. http://dx.doi.org/10.1111/j.1540-8175.2008.00686.x
[14]	Bayram, N.A., Ciftci, B., Bayram, H., Keles, T., Durmaz, T., Akcay, M., Yeter, E. and Bozkurt, E. (2008) Effects of Continuous Positive Airway Pressure Therapy on Right Ventricular Function Assessment by Tissue Doppler Imaging in Patients with Obstructive Sleep Apnea Syndrome. Echocardiography (Mount Kisco, N.Y.), 25, 1071-1078. http://dx.doi.org/10.1111/j.1540-8175.2008.00731.x
[15]	Tayyareci, Y., Nisanci, Y., Umman, B., Oncul, A., Yurdakul, S., Altun, I., Umman, S. and Bugra, Z. (2008) Early Detection of Right Ventricular Systolic Dysfunction by Using Myocardial Acceleration During Isovolumic Contraction in Patients with Mitral Stenosis. European Journal of Echocardiography: The Journal of the Working Group on Echocardiography of the European Society of Cardiology, 9, 516-521. http://dx.doi.org/10.1016/j.euje.2007.08.007
[16]	Vogel, M., Maedler, C., Williams, I., Deanfield, J. and Fraser, A. (2001) Myocardial Acceleration during Isovolumic Contraction: Effect of Age on Right and Left Ventricular Systolic Function in 225 Normals from Age 2 - 84 Years. Circulation, 104, 3536.
[17]	Hashimoto, I., Li, X.K., Bhat, A.H., Jones, M. and Sahn, D.J. (2005) Quantitative Assessment of Regional Peak Myocardial Acceleration during Isovolumic Contraction and Relaxation Times by Tissue Doppler Imaging. Heart (British Cardiac Society), 91, 811-816. http://dx.doi.org/10.1136/hrt.2004.033845
[18]	Dambrauskaite, V., Delcroix, M., Claus, P., Herbots, L., D’hooge, J., Bijnens, B., Rademakers, F. and Sutherland, G.R. (2007) Regional Right Ventricular Dysfunction in Chronic Pulmonary Hypertension. Journal of the American Society of Echocardiography, 20, 1172-1180. http://dx.doi.org/10.1016/j.echo.2007.02.005