Retrospective study of pulmonary hypertensive patients: is right ventricular myocardial performance index a vital prognostic factor?
BACKGROUND
Right ventricular function is a determinant of prognosis and survival in patients with pulmonary hypertension. The pulmonary hypertensive right ventricle has a complex shape. Transthoracic two-dimensional echocardiography is the primary examination for demonstrating right ventricular impairment. Nowadays, many indices have been linked with pulmonary hypertension. The myocardial performance index (MPI), which may be determined by both conventional Doppler and tissue Doppler imaging (TDI), is one of these.


METHODS
Ninety-three patients with pulmonary hypertension were examined retrospectively over 3 years' treatment. The relationship between MPI and right ventricular impairment was studied, as well as the correlation with various echocardiographic determinants. In addition, we examined the correlation between conventional echocardiography and tissue Doppler imaging with reference to the MPI.


RESULTS
MPI had a statistically significant relationship with the visual estimation of right ventricular impairment (r = 0.714, p = 0.001), the degree of pulmonary regurgitation (r = 0.155, p = 0.048), left ventricular eccentricity index (r = 0.299, p = 0.001 in systole) and the presence of pericardial effusion (r = 0.199, p = 0.008), while it was inversely correlated with left ventricular fractional shortening (r = -0.284, p = 0.001). However, the index had no correlation with tricuspid regurgitant velocity, right ventricular acceleration time or right atrial volume. There was significant agreement between the MPI measured by conventional Doppler echocardiography and by TDI (r = 0.83, p < 0.001; mean value -0.10, SD 0.2). Finally, some patients showed a significant decrease in tricuspid regurgitant velocity and MPI during their treatment.


CONCLUSIONS
Right ventricular MPI has a good correlation with several parameters and can be a good prognostic factor for right ventricular impairment in patients with pulmonary hypertension.
Grapsa
Ioulia
I
Department of Cardiology and Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College School of Medicine, National Heart & Lung Institute, London, UK. jgrapsa@gmail.com
Pavlopoulos
Harry
H
Dawson
David
D
Gibbs
J Simon R
JS
Nihoyannopoulos
Petros
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology