Right Ventricular Function in Pulmonary Hypertension: Clinical and Echocardiographic Correlation

INTRODUCTION: 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 multi various 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 favorably affect the overall cost of care through a focus of resources on the most effective strategies. AIMS AND OBJECTIVES: 1. To study the clinical profile of Idiopathic Pulmonary Hypertension patients. 2. To study the utility of echocardiography in assessing the right ventricular function in patients with idiopathic pulmonary hypertension. 3. To measure the Pulmonary artery systolic pressure in Idiopathic Pulmonary hypertension using Doppler Echocardiography. 4. To assess the structural abnormalities of the heart in patients with idiopathic pulmonary hypertension. 5. To study the correlation between the clinical grading of severity and echocardiographic grading of pulmonary hypertension. MATERIALS AND METHODS: About 25 patients who got admitted to the Department of Medicine and Cardiology in Govt Rajaji Hospital, Madurai between July 2006 and July 2007 were chosen and studied. The type of study : analytical study. Selection criteria and study population : Inclusion criteria: Twenty five patients (mean age 27.64±8.18 years, 22 females) who were admitted to our hospital and found have to have Pulmonary Hypertension of obscure/unknown etiology underwent a complete clinical and echocardiographic examination. In the population studied, pulmonary hypertension of varying severities were detected, as determined by Doppler echocardiography. Exclusion criteria: Pediatric age group patients were not included in the study. Patients with Chronic Obstructive pulmonary Disease, cardiomyopathy, abnormal left ventricular systolic function, valvular heart disease or congenital heart disease with Left to right shunt lesions were all excluded. The Institutional ethical committee approved the study and all patients gave informed consent to undergo evaluation. CONCLUSION: We conclude that our study population also had a strong female preponderance and had a relatively earlier onset of the disease in the 3rd or the 4th decade. The study also indicated 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 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