Correlation Between 2D Strain and Classic Echocardiographic Indices in the Diagnosis of Right Ventricular Dysfunction in COPD

Figures & data

Figure 1 Study design.

Abbreviations: ECHO, echocardiogram; TAPSE, tricuspid annular plane systolic excursion; FAC, fractional area change; S’-TDI, S-wave velocity derived from tissue Doppler imaging; TEI Index obtained from TDI, myocardial performance index derived by tissue Doppler imaging; RVGLS, right ventricle global longitudinal strain; RVFWLS, right ventricle free wall longitudinal strain; RVGLSR, right ventricle global longitudinal strain rate; RVFWLSR; RV free wall longitudinal strain rate.

Table 1 Characterization of the Profile of Patients with and without RV Dysfunction

	Without RV Dysfunction	With RV Dysfunction	Total	p
Age (years)	65.15 ± 7.98	66.54 ± 11.45	65.52 ± 8.98	0.52*
BMI	25.65 ± 5.28	24.22 ± 6.56	25.27 ± 5.64	0.29*
Walking distance (m)	447.8 ± 90.5	371.7 ± 95.8	427.8 ± 97.5	0.001*
mMRC	1.73 ± 0.91	2.21 ± 1.28	1.86 ± 1.04	0.10*
BODE (index)	2.16 ± 1.77	4.29 ± 2.22	2.73 ± 2.11	<0.001*
Sex
Female	34 (50.7)	9 (37.5)	43 (47.3)	0.26**
Male	33 (49.3)	15 (62.5)	48 (52.7)
Age group
43 to 59	14 (20.9)	5 (20.8)	19 (20.9)	0.40**
60 to 69	37 (55.2)	10 (41.7)	47 (51.6)
70 to 89	16 (23.9)	9 (37.5)	25 (27.5)
Dyspnoea
Absence	21 (31.3)	5 (20.8)	26 (28.6)	0.32**
Presence	46 (68.7)	19 (79.2)	65 (71.4)

Notes: * Student’s t-test; ** Pearson’s chi-square.

Abbreviations: BMI, body mass index; mMRC, modified dyspnoea scale (Medical Research Council); BODE (BMI calculated index, degree of obstruction, degree of dyspnoea, and walking distance).

Table 2 Characterization of the RV and Spirometric Data of Patients with and without RV Dysfunction (Mean ± SD)

	No RV Dysfunction	With RV Dysfunction	Total	p
RV Parameters
mPAP (mmHg)	29.67 ± 7.11	38.29 ± 10.11	31.95 ± 8.82	<0.001*
PT (mm)	19.09 ± 2.34	19.50 ± 2.90	19.20 ± 2.49	0.75**
Distal RVOT (mm)	26.67 ± 2.69	28.54 ± 3.67	27.16 ± 3.07	0.01*
RVSP (mmHg)	30.19 ± 8.24	51.29 ± 23.17	36.96 ± 17.60	<0.001*
Basal RV (mm)	32.46 ± 4.22	36.25 ± 6.29	33.46 ± 5.10	0.001*
Middle RV (mm)	23.60 ± 4.05	25.00 ± 6.56	23.97 ± 4.84	0.48**
Longitudinal RV (mm)	63.87 ± 9.07	63.29 ± 9.42	63.71 ± 9.11	0.79*
Spirometry
FEV1/FVC	49.87 ± 13.96	37.06 ± 11.81	46.45 ± 14.52	<0.001**
FEV1 (L)	1.54 ± 0.70	1.01 ± 0.50	1.40 ± 0.69	<0.001**
FEV1%	59.86 ± 21.62	39.90 ± 15.80	54.59 ± 22.02	<0.001*
FVC (L)	3.11 ± 1.03	2.69 ± 0.78	3.00 ± 0.98	0.07*
FVC%	94.68 ± 18.44	83.03 ± 15.96	91.61 ± 18.46	0.007*

Notes: *Student’s t-test; **Mann–Whitney.

Abbreviations: mPAP, mean pulmonary arterial pressure; PT, pulmonary trunk; distal RVOT, distal diameter of the right ventricular outflow tract; RVSP, right ventricular systolic pressure; Basal RV, basal diameter of the right ventricle; Middle RV, middle diameter of the right ventricle; Longitudinal RV, longitudinal diameter of the right ventricle; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity.

Table 3 Comparison of Myocardial Deformation Values Between Groups with and without RV Dysfunction

	Myocardial Deformation (Mean ± SD)		t	p*
	Without Dysfunction	With Dysfunction
RVGLS (%)	18.32 ± 3.66	12.65 ± 4.47	6.12	<0.001
RVFWLS (%)	22.86 ± 4.00	15.11 ± 4.22	8.03	<0.001
RVGLSR (s^−1)	1.13 ± 0.26	0.86 ± 0.23	4.41	<0.001
RVFWLSR (s^−1)	1.40 ± 0.34	1.02 ± 0.27	4.91	<0.001

Notes: *Student’s t-test.

Abbreviations: RVGLS, right ventricle global longitudinal strain; RVFWLS, right ventricle free wall longitudinal strain; RVGLSR, right ventricle global longitudinal strain rate; RVFWLSR, right ventricle free wall longitudinal strain rate.

Table 4 Result of Binary Logistic Regression Analysis

	B	Standard Error	Wald	p	Odds Ratio 95% CI (Lower–Upper)
RVGLS	−0.02	0.13	0.02	0.88	1.02 (0.80–1.30)
RVFWLS	−0.48	0.15	10.24	< 0.001	1.61 (1.20–2.16)
RVGLSR	−2.20	2.38	0.85	0.36	9.04 (0.84–97.64)
RVFWLSR	0.94	1.86	0.25	0.61	0.39 (0.01–15.06)

Note: r² = 0.42.

Abbreviations: RVGLS, right ventricle global longitudinal strain; RVFWLS, right ventricle free wall longitudinal strain; RVGLSR, right ventricle global longitudinal strain rate; RVFWLSR, right ventricle free wall longitudinal strain rate.

Table 5 Correlation Between Myocardial Deformation Parameters of the RV and Classic Echocardiographic Parameters

	RVGS	RVFWLS	RVGSR	RVFWLSR
FAC	r = 0.33; p = 0.001	r = 0.29; p = 0.01	r = 0.14; p = 0.19	r = 0.20; p = 0.06
Tricuspid S-TDI	r = 0.24; p = 0.02	r = 0.23; p = 0.03	r = 0.28; p = 0.01	r = 0.32; p = 0.001
TAPSE	r = 0.20; p = 0.05	r = 0.28; p = 0.01	r = 0.05; p = 0.65	r = 0.08; p = 0.44
MPI - TDI	r = −0.29; p = 0.01	r = −0.41; p < 0.001	r = −0.29; p = 0.001	r = −0.28; p = 0.01

Note: Pearson Correlation.

Abbreviations: FAC, fractional area change; Tricuspid S-TDI, S-wave velocity measured in the tricuspid ring through tissue Doppler imaging; TAPSE, measurement of the tricuspid ring systolic excursion with M-mode; MPI-TDI, myocardial performance index calculated through tissue Doppler imaging; RVGS, RV global strain; RVFWS, right ventricle free wall strain; RVGSR, right ventricle global strain rate; RVFWSR, right ventricle free wall strain rate.

Figure 2 ROC curve demonstrated the optimal cut-off criterion for diagnosis of right ventricle dysfunction (RVFWLS < 20%).