Use of tissue doppler imaging to detect right ventricular myocardial dysfunction in patients with chronic obstructive pulmonary disease

Objective: The objective of this study was to determine the utility of tissue Doppler imaging (TDI) in detecting early right ventricle (RV) myocardial dysfunction, given its prognostic implications in patients with chronic obstructive pulmonary disease (COPD). Methods: A prospective case-control study was carried out involving 36 COPD patients in an acute exacerbated state as cases and 34 healthy subjects serving as controls. Each subject underwent a baseline echocardiography using various methods ranging from m-mode and two-dimensional measures for analyzing RV geometry to strain and strain rate using TDI to measure RV deformation. The cases underwent a subsequent echocardiogram 1 month later once the respiratory symptoms subsided. Results: A significant difference was observed in RV tissue annular velocities (E’, A’, S) between cases and the controls at baseline. However, no significant increase was observed in tissue annular velocities among cases during remission states from baseline. Peak systolic strain in COPD group was significantly reduced in comparison to controls, but not significantly increased during remission when compared to baseline in cases. Forced expiratory volume in 1 second/vital capacity did not bear any significant correlation with RV strain. TEI index had a negative linear correlation with peak systolic strain of RV, which was statistically significant. Conclusion: TDI parameters revealed that RV dysfunction remains unaltered even in remission state of COPD despite pulmonary arterial pressure normalizing. In light of it bearing a negative prognosis in COPD, RV dysfunction merits assessment in COPD patients, both in acute exacerbations as well as in remission.