Korean Circ J.  2010 Aug;40(8):391-398. 10.4070/kcj.2010.40.8.391.

Dual Pulsed-Wave Doppler Tracing of Right Ventricular Inflow and Outflow: Single Cardiac Cycle Right Ventricular Tei Index and Evaluation of Right Ventricular Function

• Choi JO
• Choi JH
• Lee HJ
• Noh HJ
• Huh J
• Kang IS
• Lee HJ
• Lee SC
• Kim DK
• Park SW

• KMID: 2145531
• DOI: http://doi.org/10.4070/kcj.2010.40.8.391

Abstract

BACKGROUND AND OBJECTIVES
The reliability and usefulness of the right ventricular (RV) Tei index (RTX) remains controversial because it has not been possible to simultaneously measure RV inflow and outflow. However, dual pulsed-wave Doppler (DPD) enables flow velocities to be obtained at different sampling sites simultaneously. In this study we evaluated the feasibility and reliability of RTX values obtained by DPD (RTX(DPD)).
SUBJECTS AND METHODS
Forty-one patients who underwent cardiac catheterization and echocardiography for RV volume or pressure overloading conditions were evaluated. Symptom-limited exercise treadmill testing with expired gas analysis was performed and maximal exercise capacity was measured.
RESULTS
RTX by conventional flow Doppler (RTX(CFD), 0.262+/-0.164) was similar to RTX(DPD) (0.253+/-0.117, p=NS), whereas RTX by tissue Doppler echocardiography (RTX(TDE), 0.447+/-0.125) was significantly larger than RTX(DPD) (p<0.001). Based on multiple regression analysis, maximal exercise capacity was independently related to RTX(DPD) (beta=-0.60, p<0.001), mid-RV dimension (beta=-0.26, p=0.012), left ventricular ejection fraction (beta=0.22, p=0.023), and early diastolic tricuspid annular velocity (beta=0.21, p=0.048).
CONCLUSION
It is feasible and reliable to evaluate RV function using RTX(DPD) values. However, to evaluate the clinical usefulness of RTX(DPD), additional studies are required with a large number of patients and long-term follow-up.

Keyword

Echocardiography; Echocardiography, Doppler, pulsed; Cardiac function; Right ventricle

MeSH Terms

Cardiac Catheterization
Cardiac Catheters
Echocardiography
Echocardiography, Doppler
Echocardiography, Doppler, Pulsed
Exercise Test
Heart Ventricles
Humans
Stroke Volume
Ventricular Function, Right

Figure

• 

  Fig. 1 Measurement of right ventricular Tei index (RTX) by (A and B) the conventional flow Doppler method (RTXCFD), (C) the dual pulsed-wave Doppler method (RTXDPD), and by (D) tissue Doppler echocardiography (RTXTDE). RTX was defined as [(a)-(b)]/(b), where (a) is the time from tricuspid valve inflow cessation to onset for RTXCFD and RTXDPD and time from the end of A'TV to the onset of E'TV for RTXTDE, and (b) is the pulmonary ejection time for RTXCFD and RTXDPD or the duration of S'TV for RTXTDE. A'TV: late diastolic tricuspid annular velocity, E'TV: early diastolic tricuspid annular velocity, S'TV: systolic tricuspid annular velocity.

• 

  Fig. 2 Correlation (left column) and Altman-Bland plots (right column) between right ventricular Tei indexes (RTX) using conventional flow Doppler (CFD) and dual pulsed-wave Doppler (DPD; upper row); RTX using CFD and tissue Doppler (TDE; mid-row); and RTX using the DPD and TDE methods.

• 

  Fig. 3 Correlation plots of the right ventricular Tei index (RTX) vs. the S'TV (upper row), E'TV (mid-row), and maximal exercise capacity (lower row). Horizontal axes in the leftmost column represent RTX values determined using conventional flow Doppler (RTXCFD); the middle column represents RTX values determined using tissue Doppler echocardiography (RTXTDE); and the right column RTX values determined using the dual pulsed-wave Doppler method (RTXDPD). S'TV: systolic tricuspid annular velocity, E'TV: early diastolic tricuspid annular velocity.

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