P471Function and perfusion of right ventricle in patients with pulmonary hypertension. Preliminary results.


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Abstract

Background: Right ventricle (RV) function is one of the most important prognostic factors among patient with pulmonary hypertension. Echocardiographic evaluation of RV still remains difficult. We established protocol of contrast-enhanced echocardiography (CE) to improve accuracy of the RV assessment.Aim: to apply CE for the assessment of RV function and perfusion in patients with acute pulmonary embolism with RV dysfunction (PE) and pulmonary hypertension (PH) due to chronic thrombo-embolic pulmonary hypertension and pulmonary arterial hypertension.Methods: Real time CE was performed among 13 patients with PE and 13 remaining patients with PH. SonoView contrast agent was administered as a slow iv bolus (1 ml) through the peripheral vein. Both RV opacification (RVO) and myocardial contrast echocardiography (MCE) of RV were done. CE was performed using a modality of real-time perfusion imaging with low mechanical index. CE study of RV was done with delay - after full opacificaton of LV. This modality permits to avoid the strongest first pass contrast intensity in RV. From apical 4-chamber view following parameters were assessed after contrast administration: RV end–diastolic area (RVEDA), RV end-systolic area (RVESA), fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE). For perfusion evaluation RV lateral wall was divided into basal, mid and apical segments. Perfusion assessment was qualitative with standard visual method (1 – normal perfusion, 2 – perfusion defect) and quantitative using a Philips Q-LAB programme (ROI modality).Results: CE improved visualisation of RV morphology in comparison to unenhanced images. RVEDA and RVESA were significantly larger in patients with PH in comparison to PE (respectively: 30,5 vs 19,8 cm2, p=0,004; 23,7 vs 12,6 cm2, p=0,002). Although FAC was better in PE (35,5 vs 23,2 %, p=0,04) TAPSE was comparable in both groups (PE 2,2 vs 1,9 cm, p=0,2). RV perfusion assessment with standard visual method revealed perfusion defect in 42 out of 78 analyzed segments (54%) without difference between groups: PE: 21 out of 39 segments (54%); PH: 21 out of 39 segments (54%). There was unsignificant difference in RV perfusion intensity calculated with Philips Q-LAB programme: lower in PE 11,3±4,9 vs PH 13,0±7,6 dB; p=0,4.Conclusion: Implemented protocol for RVO and MCE may be applied to RV assessment among patients with pulmonary hypertension. In spite of significant differences in RVEDA, RVESA and FAC between PE and PH, RV perfusion seems to be comparable in both groups. This preliminary findings need to be confirmed among larger population.

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