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Background: Tissue Doppler imaging (TDI) of mitral (MA) and tricuspid annular (TA) events has been shown to describe systolic and diastolic properties of each respective ventricle. However, the effect of chronic elevations in pulmonary artery systolic pressure (PASP) on individual diastolic annular velocities has not been well characterized., Methods: Measurements of left (LV) and right ventricular (RV) performance and TDI of the lateral MA and TA to measure systolic and early and late diastolic velocities were recorded from 50 individuals (group I: mean age was 56 ± 15 years and mean PASP of 29 ± 6 mm Hg) and from 50 patients (group II: mean age was 55 ± 14 years and mean PASP of 83 ± 27 mm Hg)., Results: Group II patients had worse parameters of RV performance whereas LV systolic function remained unaffected when compared with group I. Group II had lower TA early velocities (0.09 ± 0.04 m/sec versus 0.12 ± 0.03 m/sec; P < 0.0001) with higher late diastolic MA velocities (0.12 ± 0.04 m/sec versus 0.10 ± 0.03 m/sec; P < 0.002) than group I. MA late diastolic velocity (P < 0.02) was the most useful in identifying elevated PASP and early diastolic TA velocity (P < 0.01) in identifying abnormal right ventricular fractional area change., Conclusion: Chronic pulmonary hypertension seems to selectively affect TDI annular diastolic velocities of both ventricles in different ways. Additional studies are needed to correlate changes in annular TDI velocities with symptoms and clinical outcomes in chronic pulmonary hypertension.

Introduction: Tissue Doppler imaging (TDI) has been a useful tool to evaluate of resting right ventricular (RV) function; however, the response of the RV to exercise has not been well established. This study attempts to determine RV mechanics at rest and immediately after exercise in healthy subjects using TDI and to define normal values., Methods: The authors studied 30 patients (mean age: 46 ± 14 years) who underwent a treadmill stress echocardiogram and had a normal exercise response without cardiac abnormalities. RV end-diastolic and end-systolic areas and RV fractional area change were measured. In addition, longitudinal RV strain and velocity generation were measured., Results: Immediately postexertion, a significant decrease in RV end-systolic area (6.4 ± 2.5 cm² versus 4.6 ± 1.5 cm², P < 0.001), increase in RV end-diastolic area (14.1 ± 4.5 cm² versus 15.3 ± 3.8 cm², P = 0.05) and a higher RV fractional area change (54 ± 6.9% versus 69 ± 7.7%, P < 0.001) were observed. RV strain increased significantly with exercise at both the base (-18.4 ± 7.7% versus -26.2 ± 10.9%, P = 0.005) and mid-RV lateral wall (-29.9 ± 8.7% versus -40.2 ± 11%, P < 0.001). RV velocity also increased significantly at both the base (8.3 ± 2.1 cm/sec versus 12.7 ± 2.5 cm/sec, P < 0.001) and mid-RV lateral wall (4.4 ± 1.6 cm/sec versus 8.1 ± 4.1 cm/sec, P = 0.001)., Conclusion: Immediately postexercise, TDI seems to be a useful tool for assessing RV mechanics and function. Whether RV velocity and strain may be used to detect subclinical RV dysfunction during exercise will require further study.

Background: Worsening degrees of tricuspid regurgitation (TR) have been associated with worse outcomes. We investigated the time it takes for the TR jet to attain its maximum peak (tmpTR) with measures of right ventricular (RV) function., Methods: Several echocardiographic variables of RV size and function and tmpTR corrected for heart rate were collected from 140 patients (mean age 57 +/- 20 years)., Results: Mean RV end systolic (15 +/- 9 cm) and end diastolic (25 +/- 9 cm) areas, RV fractional area change (44 +/- 19%), maximal tricuspid annular motion (1.98 +/- 0.71 cm), pulmonary artery systolic pressure (57 +/- 33 mm Hg) and tmpTR (248 +/- 75 ms). A negative correlation was seen between tmpTR and RV fractional area change (r = -0.74; P < 0.0001) and between tmpTR and maximal tricuspid annular excursion (r = -0.69; P < 0.0001). On a multiple stepwise linear regression analysis tmpTR was better than pulmonary artery systolic pressure in predicting RV dysfunction (P < 0.001). Receiver operating characteristic curve analysis demonstrated that a tmpTR value >240 ms identified RV systolic dysfunction (sensitivity 79% and specificity 94%, areas under the curves 0.923, P = 0.0001). The longest tmpTR values were seen in patients with both RV systolic dysfunction and pulmonary hypertension (310 +/- 30 ms, P < 0.0001)., Conclusion: A delayed time to peak of the maximum TR jet correlates with RV dysfunction. Patients with normal RV function and no pulmonary hypertension had abnormal tmpTR values (243 +/- 57 ms) implying an underlying RV mechanical abnormality that requires further investigation.