Background: Right ventricular (RV) function is a powerful prognostic marker in pulmonary arterial hypertension (PAH), but its noninvasive evaluation is still difficult. RV ejection fraction determined by CMRI is considered the gold standard for RV systolic function evaluation. Tissue Doppler Imaging (TDI) has been used to assess RV function in congestive heart failure, but few data exist concerning its value in PAH.

Objectives: To compare systolic RV function using cardiac MRI and TDI in patients with PAH.

Methods: Complete echocardiographic studies including tricuspid annular velocity measurements by TDI were performed in 83 consecutive PAH patients (17 idiopathic and 66 related to other conditions such connective tissue disease (15), chronic thromboembolic pulmonary disease (15), congenital heart diseases (11), HIV infection (8), portal hypertension (7), use of appetit suppressant drugs (4) and others (6)) and in 15 controls. RV function was assessed by standard echocardiography using RV area fractional shortening (FS). Systolic (S) and early diastolic (D) annular velocities, and RV myocardial performance index (MPI) were measured by DTI in all patients. Cardiac MRI was performed in 37 among 83 PAH patients and RV ejection fraction was caculated on multiplane slices in using Simpson Method.

Results: S was lower in PAH than in controls (10.3 ± 2.7 vs 14.2 ± 2.5 cm/sec, p < 0,001) and was related to RVFS (r = 0.43, p < 0,001). E was lower in PAH than in controls (9,1 ± 3.7 vs 13.2 ± 2.5 cm/sec, p = 0.001). MPI was higher in PAH than in controls (0.69 ± 0.23 vs 0.37 ± 0.1 p < 0.001) and had an inverse correlation with S (r = -0.52, p < 0.001).

S (cm/sec) was positively correlated with RVEF (%) determined by MRI (r = 0,50 p < 0,001).

Conclusion: In addition to conventional echocardiography, TDI assessment of tricuspid annular velocities allows a rapid evaluation of RV function in PAH, with relatively good correlation with MRI measurement.