Echocardiographic parameters comparison between the impact of primary pulmonic artery hypertension class l and secondary pulmonary venous hypertension class ll on right heart function and size

Abstract

PH is a main source of pathophysiological in RV failure, when it comes to the hemodynamic status of the pre- and post-capillary networks and their relationship to pulmonary capillary wedge pressure, therefore the major contribution of TTE is to differentiate between PH secondary to LHD post-capillary and PAH or other precapillary PH because of the variety of treatment management between these entities. Due to the limited number of studies undertaken so far about the probable parameters to evaluate right side size and function provided by echocardiography to distinguish between patients presenting with class I and those with class II PH, are limited. The purpose of this study therefore was to compare the right heart's overall function in the setting of PH in patients with class I and class II echocardiogram parameters. The purpose of this study is to evaluate the to investigate whether there's a difference in the RV's overall function between classes I and II PH. In addition to evaluate the reproducibility of RV global strain on both group. Method: PH data was recruited prospectively which included total 127 patients , 7.1% (n=9) normal group were scanned prospectively for comparison, 46.5% (n=59) class l PH and 46.5% (n=59) class ll PH. They were 62 male (48.8%) and 65 female (51.2%), averaging an overall age at 60.8 ± 18.9 years, ranging from 17 to 92 years. 2D echocardiography Scanned was performed using either Philips (EPIQ Cvx 7.0.5) and GE (Vivid 9 ) ultrasound system with phased array transducer (1.0 to 5.0 MHz). A qualitative and qualitative heart chambers assessment using 2D , m-mode color , pulse and continuous doppler. Results: RV size cavity were found significantly enlarged with impaired systolic function for the most class l more than class ll PH patients. The right heart was found to be predominant as a key feature of class l PH to differentiate it from class ll were LV found predominant. TRvmax , SPAP , FAC , RV strain showed significant deference between both PH types. However, the TAPSE and S’velocity wasn’t reliable for TV dysfunction assessment on our study. Moreover, the RV global strain used in our study as direct evaluation of myocardial deformation which reflects different abnormal values in class l than class ll PH. Also , RV GLS reported an excellent reliability intra , inter-examiners test in overall group. Conclusion: Right heart found to be difference for the most parameters when compared class l with class ll PH as the prognostic and clinical relevance of RV function to differentiate class l from class ll is yet to be determined. A detailed TTE evaluation of PAP and heart chambers remodeling acknowledges selecting the PH patients with high risk factors and play an important role in differentiate between class l and ll PH.