The Effect of Chronic Pulmonary Hypertension on Diastolic Annular Tissue Velocities: A Pilot Study

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.