Tricuspid Flow Propagation Velocity Predicts Exercise Tolerance and Readmission in Patients With Systemic Lupus Erythematosus

Pilot study shows right ventricular diastolic function impairment in young children with obstructive respiratory disease

AIM

This study determined cardiovascular impairment in young children with obstructive respiratory disease who were assessed using the opening interrupter technique (RINT).

METHODS

This pilot study enrolled 41 children who had been referred to pulmonology and allergology specialists at the University of Catania, Italy, from March to July 2017: 23 (mean age 4.13 ± 0.62 years) had chronic coughs and wheezing and 18 controls (mean age 4.27 ± 0.66 years) had obstructive chest disease, but were otherwise healthy. Airway resistance was evaluated using RINT and cardiac function by studying the ejection fraction, pulmonary artery systolic pressure (PASP), tricuspid annular plane systolic excursion and tricuspid flow propagation velocity (TFPV).

RESULTS

The RINT and PASP values were significantly higher in the patient group when compared to the controls, but the TFPV values were lower. A direct and significant Spearman's correlation coefficient (r) between RINT and PASP values was observed (r = 0.81). We found a significant inverse correlation between RINT and TFPV (r = -0.83), as well as TFPV and PASP (r = -0.78).

CONCLUSION

This study showed that children with obstructive respiratory diseases had a major risk of cardiovascular impairment. Impaired diastolic function of the right ventricle occurred very early when airway resistance was abnormally increased.

[Right ventricular diastolic function in patients with lung diseases in the absence or presence of pulmonary hypertension]

AIM

To investigate the indicators of filling of the right ventricle (RV) in patients with chronic lung diseases with and without pulmonary hypertension (PH) compared to healthy individuals.

SUBJECTS AND METHODS

365 people (198 men); mean age 64.6±8.0 years) were examined and divided into a group of patients with respiratory pathology without and with PH (n=124 and n=138, respectively) and a comparison group that included individuals without cardiovascular and respiratory diseases (n=103). All underwent echocardiography with examination of RV filling flows (Et, At, Et/At), data of the spectral tissue Doppler imaging of the fibrous ring of the tricuspid valve (e't, a't, e't/a't), and early tricuspid flow propagation velocity (ETFPV).

RESULTS

All the groups were found to have an e't/a't decrease to 0.75 (0.63-0.90) - 0.8 (0.63-1.0; p=0.26). The groups showed no noticeable differences in indicators, such as Еt/Аt, e't/a't, and Еt/e't ratios, although the increased size of the right heart was noted in patients without PH along with the ETFPV decrease from 33.5 (28-39) to 31.5 (24.5-36) cm/sec, which continued to substantially decline to 27.1 (24-35) cm/sec in patients with PH (p<0.0001).

CONCLUSION

Patients with chronic lung disease even without the development of PH exhibited a decreased ETFPV along with the increased size of the right heart. Another indicator of RV diastolic function is a tricuspid valve annular velocity ratio in early and late diastole; the e't/a't ratio was not considerably different in the groups, although its decline was observed in all the groups probably due to age-related changes. Thus, RV diastolic function should be comprehensively evaluated in patients with lung disease regardless of the presence of PH.