Evaluation of Right Ventricular Dysfunction Using Echocardiography as a Diagnostic Tool to Rule Out Pulmonary Hypertension

Abstract

Background: Pulmonary hypertension increases right ventricular afterload and may lead to progressive right ventricular dysfunction. Echocardiography provides a non-invasive means of evaluating right ventricular structure, systolic function, and pressure-related abnormalities. Objective: To evaluate right ventricular dysfunction using echocardiography and examine the associations and discriminatory performance of selected echocardiographic parameters in patients assessed for pulmonary hypertension. Methods: This cross-sectional observational study included 62 patients evaluated at Bajwa Hospital, Lahore. Tricuspid annular plane systolic excursion, tricuspid valve pressure gradient, right ventricular systolic tissue Doppler velocity, right ventricular dilation, inferior vena cava collapsibility, and tricuspid regurgitation grade were assessed. Continuous variables were compared using Welch’s independent-samples t-test, while categorical associations were evaluated using chi-square tests. Receiver operating characteristic analysis was performed with clinically appropriate test directions. Results: Pulmonary hypertension was identified echocardiographically in 38 participants (61.3%). Compared with participants without pulmonary hypertension, affected participants had lower TAPSE (14.79 ± 4.22 vs 19.54 ± 2.60 mm; mean difference −4.75 mm, p < 0.001), higher TVPG (49.79 ± 7.95 vs 28.63 ± 5.98 mmHg; mean difference 21.16 mmHg, p < 0.001), and lower RV S′ TDI (9.00 ± 2.90 vs 11.58 ± 2.41 cm/s; p < 0.001). Right ventricular dilation was strongly associated with pulmonary hypertension (OR 28.33, 95% CI 6.51–123.40). TVPG showed the highest discriminatory performance (AUC 0.969). Conclusion: A multiparametric echocardiographic assessment identified substantial right ventricular structural and functional differences associated with pulmonary hypertension. Echocardiography is useful for initial evaluation but should not replace confirmatory hemodynamic assessment