Utility of tissue Doppler imaging in predicting outcome in patients with idiopathic pulmonary fibrosis.
BACKGROUND
There are limited reports in the literature concerning right ventricular (RV) performance in patients with non end-stage idiopathic pulmonary fibrosis (IPF) who exhibit mild to moderate pulmonary hypertension (PH). We evaluated RV functional impairment in such a cohort using both conventional echocardiography and tissue Doppler imaging (TDI) and in addition we assessed the association of specific TDI indices with survival.


METHODS
Twenty-two clinically stable patients with non-end stage IPF and mild to moderate PH were assessed. Twenty-two healthy individuals served as controls. We evaluated RV systolic and diastolic function and further estimated peak pulmonary artery systolic pressure (PASP). In addition, by combining TDI and Doppler echocardiography, we calculated the ratio of trans-tricuspid E-wave velocity to early diastolic tricuspid annulus velocity (RV E/Em). Patients were followed for a median period of 22 months and the incidence of death was recorded.


RESULTS
Both echocardiographic modalities revealed impaired RV systolic and diastolic function in the IPF group compared to controls. A significant negative correlation was observed between RV E/Em and PASP (r = -0.5, p = 0.018). The probability of survival was 54.5% for those patients with RV E/Em < 4.7 versus 100% for those with an index > 4.7 (log-rank statistic 5.81, p = 0.016).


CONCLUSIONS
TDI modality may serve as an alternative to conventional ultrasound technique for risk stratification and PH estimation in non end-stage IPF patients.
Pitsiou
Georgia
G
Respiratory Failure Unit, Papanikolaou General Hospital, Thessaloniki, Greece.
Papadopoulos
Christodoulos E
CE
Karvounis
Haralambos I
HI
Karamitsos
Theodoros D
TD
Giannakoulas
Georgios
G
Efthimiadis
Georgios
G
Kontakiotis
Theodoros
T
Argiropoulou
Paraskevi
P
Parharidis
Georgios E
GE
D000368:Aged; D016022:Case-Control Studies; D003971:Diastole; D004452:Echocardiography; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011658:Pulmonary Fibrosis / Q000150:complications / Q000000981:diagnostic imaging*; D012129:Respiratory Function Tests; D012307:Risk Factors; D012720:Severity of Illness Index; D013599:Systole; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*