Assessment of Right Ventricular function by Echocardiography in Pulmonary Hypertension.

INTRODUCTION : “When you solve one difficulty, other new difficulties arise. You then try to solve them. You can never solve all difficulties at once” - P.A.M.CHIRAC. It is this spirit of learning more about how echocardiography can be used to evaluate Right ventricle function in pulmonary hypertension patients, which helps us. With multivarious etiologies causing pulmonary hypertension, making an accurate diagnosis, evaluating for the cause, monitoring the disease course and detecting complications of the disease has always been a challenge. Selecting the most appropriate for screening, diagnosing and monitoring the disease has been a subject of controversy. Although there is no consistent and large data available in India revealing the exact incidence and prevalence of the disease, the increase in disease burden is certainly palpable and will continue to increase with time. With high mortality rates if left untreated and with very little treatment options in our hands, it definitely poses a challenge to the medical fraternity for an early diagnosis and intervention before complications intervene. Most common cause of death in pulmonary hypertension is right ventricular failure. Unfortunately most patients present to us too late for any kind of meaningful intervention. So as physicians, it is important for us to play a critical role in the evaluation of the use of appropriate diagnostic procedures and therapy modalities in the early detection and treatment of this disease. Rigorous and expert analogues of the available data that document the relative benefits and risks of the procedures can produce helpful guidelines that improve the effectiveness of care optimize patient outcomes and favourably affect the overall cost of care through a focus of resources on the most effective strategies. AIMS AND OBJECTIVES : To study the clinical profile of Idiopathic Pulmonary Hypertension patients. To study the utility of echocardiography in assessing the right ventricular function in patients with idiopathic pulmonary hypertension. To measure the Pulmonary artery systolic pressure in Idiopathic Pulmonary hypertension using Doppler Echocardiography. To assess the structural abnormalities of the heart in patients with idiopathic pulmonary hypertension. To study the correlation between the clinical grading of severity and echocardiographic grading of pulmonary hypertension. CONCLUSIONS : We conclude that our study population also has a strong female preponderance and has a relatively earlier onset of the disease in the 3rd or the 4th decade. The study also indicates that right ventricular abnormalities occurs in patients with chronic idiopathic pulmonary hypertension and is strongly correlated with right atrial dimensions, right ventricular size and main pulmonary artery size, which are all increased with increasing severity in pulmonary hypertension. Other structural abnormalities in pulmonary hypertension include presence of pericardial effusion, paradoxical septal motion of IVS and pulmonary valve abnormalities (absent ‘a’ wave and presence of mid systolic notch or closure). In addition, right ventricular functional abnormalities including RV FAC and RV MPI are associated with disease severity and it correlates well with pulmonary hypertension severity index, World Health Organization class. RV FAC decreases with increase in severity of pulmonary hypertension and MPI increases with increases with increase in PASP. Right ventricular dysfunction is clearly evident even with mild elevations in the pulmonary artery systolic pressure and Doppler echocardiography is the test of choice in patients suspected to have Idiopathic Pulmonary artery hypertension