Evaluation of Right Ventricular Diastolic Function in Patients with Chronic Obstructive Pulmonary Disease Using Pulsed Doppler Tissue Imaging

Objective: To evaluate the global and segmental diastolic function of the right ventricle using pulsed tissue Doppler imaging (TDI) in patients with clinically stable chronic obstructive pulmonary disease (COPD) without pulmonary hypertension (PHT).

Methods: Twenty stable patients with COPD (mean age 61.4±8.6, 16 males) with normal pulmonary artery pressure (PAP) (Group I) and 20 age-matched normal subjects (mean age 57.8±4.0, 11 males, Group II) were enrolled. All the participants underwent conventional echocardiography and TDI. TDI of the right ventricle was performed from four different segments. The early myocardial diastolic peak velocity (Em), late myocardial diastolic peak velocity (Am), systolic peak velocity (Sm), early diastolic velocity deceleration time (eDTm), duration of the S wave, isovolumetric relaxation time (IVRTm), and isovolumetric contraction time (IVCTm) were measured.

Results: The conventional echocardiographic measurements of the two groups were similar, but specific TDI parameters differed between the groups. The Em of the anterior wall was lower, and the duration of the anterior S wave and IVRTm in the apical 4-chamber (A4C) view for all the right ventricular (RV) segments were longer. The eDTm measured from the apex was shorter in the COPD patients (parasternal Em, p=0.003; duration of anterior wall S wave, p=0.02; A4C apical IVRTm, p=0.02; A4C middle IVRTm, p=0.001; A4C basal IVRTm, p=0.01; A4C apical eDTm, p=0.05).

Conclusion: TDI was more sensitive than conventional echocardiography in the evaluation of diastolic function in the patients with COPD. In COPD patients with an unlikely diagnosis of PHT, the diastolic functions of the right ventricle seemed to show some deterioration, but this difference failed to reach a significant level. Measurements of the basal segment of the RV free wall can be used to determine global RV diastolic function.