To investigate right ventricular morphology and function by Doppler ultrasound in post-kidney-transplant patients and to define relative correlation between them and left ventricular hypertrophy. Subjects and methods: 93 post-kidney-transplant patients were undergone clinical examinations, blood tests and echocardiography (2D, TM, Doppler) to evaluate right ventricular morphology and functions. Results: The mean age of studied patients was 38.09 ± 9.9 years. Right ventricular base dimension: 33.13 ± 4.5 mm; right ventricular middle dimension: 28.76 ± 4.46 mm; riight ventricular long dimension: 62.65 ± 7.53 mm; tricuspid annular plane systolic excursion: 21.07 ± 2.5 mm; right ventricular fractional area change: 0.45 ± 0.06; 4.3% pulmonary hypertension, Tei right ventricular: 0.26 ± 0.1; Tei right ventricular (tissue Doppler imaging): 0.57 ± 0.11. There was no relationship between them and left ventricular morphology index. Conclusion: Right ventricular base dimension, Right ventricular middle diameter increased 2.2%, 5.4%, respectively; normal right ventricular long dimension and tricuspid annular plane systolic excursion were normal in 100% of patients, increased right ventricular fractional area change 3.2%, increased Tei right ventricular 17.2%, increased Tei right ventricular (tissue Doppler imaging) 58.1%.
Journal of military pharmaco-medicine n02-2019 STUDY ON RIGHT VENTRICULAR MORPHOLOGY AND FUNTION BY DOPPLER ULTRASOUND IN KIDNEY POST-TRANSPLANT PATIENTS Hoang Dinh Anh1; Nguyen Thi Ly2; Nguyen Thi Hoang Oanh1 Pham Thi Dieu Huong1; Nguyen Vu Thang1 SUMMARY Objectives: To investigate right ventricular morphology and function by Doppler ultrasound in post-kidney-transplant patients and to define relative correlation between them and left ventricular hypertrophy Subjects and methods: 93 post-kidney-transplant patients were undergone clinical examinations, blood tests and echocardiography (2D, TM, Doppler) to evaluate right ventricular morphology and functions Results: The mean age of studied patients was 38.09 ± 9.9 years Right ventricular base dimension: 33.13 ± 4.5 mm; right ventricular middle dimension: 28.76 ± 4.46 mm; riight ventricular long dimension: 62.65 ± 7.53 mm; tricuspid annular plane systolic excursion: 21.07 ± 2.5 mm; right ventricular fractional area change: 0.45 ± 0.06; 4.3% pulmonary hypertension, Tei right ventricular: 0.26 ± 0.1; Tei right ventricular (tissue Doppler imaging): 0.57 ± 0.11 There was no relationship between them and left ventricular morphology index Conclusion: Right ventricular base dimension, Right ventricular middle diameter increased 2.2%, 5.4%, respectively; normal right ventricular long dimension and tricuspid annular plane systolic excursion were normal in 100% of patients, increased right ventricular fractional area change 3.2%, increased Tei right ventricular 17.2%, increased Tei right ventricular (tissue Doppler imaging) 58.1% * Keywords: Kidney transplantation; Right ventricular; Echocardiography INTRODUCTION Kidney transplantation is the best treatment for patients with end-stage chronic renal failure After transplanting, renal function is restored It has improved the secretion and endocrine function of the kidney However, in post-kidney-transplant patients still exist or appear the danger which affecting the survival of the transplant kidney and patients In the world and in Vietnam, there have been many studies on left ventricular morphology and function disorders in patients with chronic renal failure and variations of ultrasound indexes evaluated left ventricular morphology and function in post-kidney-transplanted patients Along with cardiovascular risk factors, patients with chronic renal failure have changed morphology and systolic and diastolic dysfunction of left ventricular, vein ventilation holes are one of the factors that increase chronic overload for the right ventricular which does not depend on the total water of body that increases the risk of right ventricular overload 103 Military Hospital Corresponding author: Pham Thi Dieu Huong (huongdr106 @gmail.com) Date received: 20/12/2018 Date accepted: 23/01/2019 207 Journal of military pharmaco-medicine n02-2019 In Vietnam, there has not been any studies on right ventricular morphology and function in post-kidney-transplanted patients So, we carry out this topic with the following objectives: Investigating right ventricular morphology and function by Doppler ultrasound in post-kidneytransplanted patients and to define relative correlation between them and hypertrophy left ventricular SUBJECTS AND METHODS excursion (TAPSE) < 16 mm, index fractional area change (FAC) < 0.35; increase TeiRV index when TeiRV > 0.4; increase TeiRV issue index when TeiRVm > 0.55 [5] - Evaluation of mass index of left ventricular, thick wall of left ventricular according to ASE 2005 [2] - Data processing: Data were entered and processed by statistical software in SPSS 23.0 RESULTS AND DISCUSSION Subjects - We studied 93 post-kidney-transplanted patients who was treated and monitored after transplantation at 103 Military Hospital from October 2016 to July 2017 - Exclusion criteria: Kidney-transplanted patients with functional loss must be replaced kidneys by other methods, fever, infection, pregnancy, malignancy, heart valve disease Post-kidney-transplant patients who under 40 years old accounted for over 60%, the oldest was 64 while the youngest was 15, the mean age was 38.09 ± 9.9 The ratio of male/female patients was 2.87:1 Table 1: Right ventricular morphology and function on 2D and TM ultrasound Index Classify Patients Percent (n = 93) (%) Methods - Descriptive, cross-sectional study, intra-group comparison and comparison with reference values - Echocardiography was performed at functional diagnostic department: TM, 2D, Doppler (color, pulse, continuity, tissue) ultrasound with LogiqS8 GE ultrasound machine, with Doppler ultrasound and tissue Doppler imaging (TDI) software - The value of right ventricular ultrasound parameters according to ASE 2010: Right ventricular relaxation when right ventricular base dimension (RVBD) > 42 mm, reduced systolic function of right ventricular when index tricuspid annular plane systolic 208 RVBD (mm) Increase 2.2 Normal 91 97.8 RVMD (mm) Increase 5.4 Normal 88 94.6 RVLD (mm) Increase 0 Normal 93 100 Normal 90 96.8 Decrease 3.2 Normal 93 100 Decrease 0 RVFAC (%) TAPSE (mm) Mean value X ± SD 33.13 ± 4.5 28.76 ± 4.46 62.65 ± 7.53 0.45 ± 0.06 21.07 ± 2.5 Evaluating the size of the right ventricle showed that the mean value of right ventricle's bottom diameter (RVBD) was 33.13 ± 4.5 mm, at the papillary Journal of military pharmaco-medicine n02-2019 position (RVMD) was 28.76 ± 4.46 mm, right ventricular long dimension (RVLD) was 62.65 ± 7.53 mm According to ASE classification, among study patients, only 2.2% increased RVBD (right ventricular dilatation), 5.4% of patient increased right ventricular diameter at papillary position and none of them increased right ventricular long dimension Evaluating TAPSE on TM ultrasound, the end result showed 100% of patients with TAPSE index in normal range, average value of 21.07 ± 2.5 mm To assess the right ventricular systolic function we used RVFAC index, the results showed normal in 90 patients (96.8%) and 3.2% of patients with RVFAC index decreased According to Hewing, who assessed right ventricular function in patients after kidney transplant with TAPSE and RVS index, the average value of TAPSE in post-transplant patients had the same results as our study 23.3 ± 5.6 mm, S was 12.7 ± 2.9 cm/s In study of the author also showed that the function of right ventricular in patients before and after kidney transplant was constant Table 2: Doppler untrasound index trcuspid valve and pulmonary valve assessed right ventricular function Index X ± SD (n = 93) E (cm/s) 50.53 ± 13.27 A (cm/s) 45.98 ± 13.01 DT (ms) 151.3 ± 41 E/A 1.16 ± 0.37 0.26 ± 0.16 TeiRV Normal Increase 77 (82.8%) 16 (17.2%) 22.97 ± 3.62 PAPs (mmHg) Normal Increase 89 (95.7%) (4.3%) Studying Doppler parameters though tricuspid valve and pulmonary valve, the result showed that: The mean value of the Tei index in the study was 0.26 ± 0.16; patients who increased TeiRV index accounted for 17.2% There were 4/93 patients increased systolic pulmonary artery pressure Evaluation of right ventricular systolic function must be based on Doppler ultrasound through tricuspid valve showed that the mean value of wave A was 50.53 ± 13.27 cm/s and the E/A ratio was 1.16 ± 0.37, smaller than the mean value on normal adults, according to the study by Pham Gia Khai [1] It means: Patients after transplantation still had right ventricular diastolic dysfunction Some studies assessed right ventricular function in chronic renal failure patients According to Floccari (2012), who assessed right ventricular function in 202 patients with chronic kidney disease stage III (according to NKF), TAPSE < 18 mm in 44.5% of patients Systolic pulmonary artery pressure above 30 mmHg: 28.7%, above 40: 5% of patients [3] Or according to the study by Bui Van Tuan (2014), the rate of pulmonary arterial pressure increased in patients with chronic renal failure (43%) These changes in TAPSE and pulmonary arterial pressure are relatively common in patients with chronic 209 Journal of military pharmaco-medicine n02-2019 renal failure In our study, no patients had reduced TAPSE less than 16 mm, only 4.3% of patients increased systolic pulmonary artery pressure Thus, the group of patients in our study had a kidney transplantation compared with authors studied in patients with end-stage chronic renal failure showed that the function of right ventricle has been significantly improved, the rate of patients with increased pulmonary artery pressure reduced pretty much Table 3: Characteristics of right ventricular tissue Doppler imaging at position of tricuspid valve Index Minimum value Maximum value Mean value ( X ± SD, n = 93) 12.51 ± 2.78 S (cm/s) 21 Normal Decrease 78 (83.9%) 15 (16.1%) Em (cm/s) 18 9.98 ± 2.69 Am (cm/s) 23 12.76 ± 4.4 ICTm (ms) 27 107 66.06 ± 17.59 IRTm (ms) 37 118 71.7 ± 15.6 ETm (ms) 170 334 243.41 ± 33.89 0.57 ± 0.11 Teim 0.31 In order to evaluate right ventricular function, we performed tissue Doppler imaging at the position of tricuspid valve There results showed that the mean value of S-systolic wave on tissue Doppler imaging was 12.51 ± 2.78 cm/s Patients with reduced S wave velocity was 16.1% The Tei index of tissue Doppler in the study was 0.57 ± 0.11, in which 58.1% of patients had increased Teim index According to the study by H.Oflaz, when the study evaluated the effects of cyclosporine on right and left ventricular functions on 66 patients after kidney transplantation He found that the average 210 0.76 Normal Increase 41.9% 58.1% S wave velocity was 10 ± 2.3 cm/s, this index also no difference when observed at different times after transplantation (< years, - years, > years) [4] When assessing systolic and diastolic right ventricular function by Tei index, we found that the mean right ventricular Tei index: 0.26 ± 0.16, in which 82.8% of patients had right ventricular Tei within normal limits, only 17.2% of patients had increased Tei index The Tei index on Doppler was based on the flow through the tricuspid valve and pulmonary artery valve, changes and depends on the patient's breathing Therefore, when we evaluated on Doppler tissue, only 41.9% Journal of military pharmaco-medicine n02-2019 of patients had Tei index in the normal range (< 0.55); 58.1% of patients had Tei index increased The difference in results when assessing right ventricular function required us to use many ultrasound methods, many studies showed that Tei index evaluated on TDI of both left and right ventricles must be more valuable than index Tei evaluated by Doppler through bicuspid and tricuspid valves Table 4: Relation between left ventricular hypertrophy and right ventricular ultrasound indexes Left ventricular hypertrophy Index p No ( n = 62) Yes ( n = 31) RVBD (mm) 32.64 ± 4.3 34.12 ± 4.78 > 0.05 FAC 0.46 ± 0.06 0.44 ± 0.06 > 0.05 TAPSE (mm) 20.82 ± 2.42 21.73 ± 2.68 > 0.05 E (cm/s) 50.56 ± 13.5 50.48 ± 13.01 > 0.05 A (cm/s) 45.87 ± 13.12 46.22 ± 12.98 > 0.05 E/A 1.16 ± 0.34 1.16 ± 0.42 > 0.05 Tei 0.24 ± 0.13 0.29 ± 0.2 > 0.05 Em (cm/s) 6.95 ± 2.21 7.19 ± 2.19 > 0.05 Am (cm/s) 5.48 ± 2.02 5.11 ± 2.20 > 0.05 S (cm/s) 12.48 ± 2.71 12.58 ± 2.96 > 0.05 Teim 0.58 ± 0.11 0.56 ± 0.12 > 0.05 Assessing the relationship between right ventricular parameters and left ventricular hypertrophy, we assessed the amount of ventricular muscle mass, 62 patients with left ventricular hypertrophy and 31 patients without left ventricular hypertrophy The results showed that there was almost no clear correlation of right ventricular morphological and functional parameters with left ventricular hypertrophy However, in patients with renal transplant, there were the changes in left ventricular parameters, not only left ventricular hypertrophy, perhaps because the number of patients was not enough, requiring to study in larger groups with more left ventricular parameters CONCLUSION - Renal transplant patients had right ventricular dilatation with increased RVBD, RVMD by 2.2% and 5.4%, 100% of patients had normal RVLD - Right ventricular function evaluation index TAPSE was normal in 100%, reduced RVFAC in 3.2% of patients On Doppler ultrsound, 17.2% of patients had an increase in right ventricular Tei index, but on tissue Doppler imaging increased the Tei right ventricular index in 58.1%, so it is necessary to comprehensively evaluate the right ventricular function on TM, Doppler and tissue Doppler imaging 211 Journal of military pharmaco-medicine n02-2019 REFERENCES Phạm Gia Khải Bước đầu nghiên cứu thông số siêu âm Doppler tim dòng chảy qua van tim người lớn bình thường Trường Đại học Y Hà Nội 1996, 62 Nguyễn Anh Vũ Siêu âm tim - Cập nhật chẩn đoán Nhà xuất Đại học Huế Bệnh viện Đại học Y Dược Huế 2010, 335 Di Lullo L, Floccari F, Rivera R et al Assessment of right ventricular function in patients with chronic kidney disease stage IV NKF G Ital Nefrol 2013, 30 (5) Oflaz H, Turkmen A, Kocaman O et al Is there a relation between duration of 212 cyclosporine usage and right and left ventricular function in renal transplant patients? Tissue Doppler echocardiography study Transplantation Proceedings 2004, 36 (5), pp.1380-1384 Rudski L.G, Lai W.W, Afilalo J et al Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography J Am Soc Echocardiogr 2010, 23 (7), pp.685713 ... objectives: Investigating right ventricular morphology and function by Doppler ultrasound in post-kidneytransplanted patients and to define relative correlation between them and hypertrophy left ventricular. .. RVLD - Right ventricular function evaluation index TAPSE was normal in 100%, reduced RVFAC in 3.2% of patients On Doppler ultrsound, 17.2% of patients had an increase in right ventricular Tei index,... mm, right ventricular long dimension (RVLD) was 62.65 ± 7.53 mm According to ASE classification, among study patients, only 2.2% increased RVBD (right ventricular dilatation), 5.4% of patient increased