C  2007, the Authors Journal compilation C  2007, Blackwell Publishing, Inc. DOI: 10.1111/j.1540-8175.2007.00378.x Value of Tissue Doppler Myocardial Velocities of Tricuspid Lateral Annulus for the Diagnosis of Right Heart Failure in Patients with COPD Sibel Turhan, M.D., Irem Dinc ¸er, M.D., Cagdas Ozdol, M.D., Uzeyir Rahimov, M.D., Mustafa Kılıc ¸kap, M.D., Timucin Altın, M.D., Cansın Tulunay, M.D., G¨ unes ¸ Akgun, M.D., and Cetin Erol, M.D. Cardiology Department, Faculty of Medicine, Ankara University, Ankara, Turkey Objective: Aim of this study was to investigate the value of systolic indices of tricuspid valve annular motion measured by tissue Doppler imaging for the diagnosis right ventricular failure in patients with chronic obstructive pulmonary disease (COPD). Methods: Patients with COPD with right heart failure symptoms and/or right ventricular dilatation were enrolled for the study. The control group consisted of age and sex matched patients referred to the echocardiography laboratory who had nor- mal echocardiographic examination. Tricuspid valve annulus peak systolic velocity and myocardial acceleration during isovolumic contraction were recorded by tissue Doppler imaging. Results: IVA and Sa wave velocities were found to be significantly decreased in patients with right ventricular failure. For the prediction of right heart failure IVA <3.8 m/sec 2 had 91% sensitivity, 80% specificity, 90% positive predictive value (PPV), and 82% negative predictive value (NPV) and Sa wave velocity <9.2 cm/sec had 80% sensitivity, 62% specificity, 75% PPV, and 68% NPV. Conclusion: Tricuspid valve annular velocities measured by tissue Doppler imaging especially IVA, offer potential diagnos- tic value for the diagnosis of right heart failure in patients with COPD. (ECHOCARDIOGRAPHY, Volume 24, February 2007) isovolumetric acceleration, chronic obstructive pulmonary disease, tissue Doppler echocardiography Pulmonary hypertension is a common com- plication in patients with chronic obstructive pulmonary disease (COPD). Severe pulmonary hypertension by increasing right ventricular af- terload leads to clinical syndrome of right heart failure with systemic congestion. Although ex- act incidence is not known, prevalence of right heart failure secondary to COPD was estimated to be 10%–30%. 1,2 In these patients prognosis is poor because of right ventricular failure added to ventilatory insufficiency. 3 Due to the complex geometry of right ventricle, evaluation of right ventricular function is very difficult. Radionu- clide ventriculography, cardiac catheterization, and cardiac magnetic resonance imaging (MRI) could be used for the assessment of right ven- tricular function. 4–6 However, these methods are time consuming and not widely available. Furthermore, invasive measurements are not These authors contributed equally to this work Address for correspondence and reprint requests: Irem Dinc ¸er, M.D., Metis Doruk Sitesi F Blok No 4, Keklikpınarı Dikmen, Ankara, Turkey. Fax: +90-312-312-52-51; E-mail: idincer@medicine.ankara.edu.tr acceptable for screening purposes. For nonin- vasive evaluation, echocardiography has made progress with the tissue Doppler echocardiog- raphy. Measurement of systolic wave velocities (Sa) by tissue Doppler imaging (TDI) has been shown to be well correlated with right ventric- ular ejection fraction. 7,8 However, loading con- ditions have an effect on the systolic velocities measured by TDI. 9 Recently, isovolumic acceleration (IVA) dur- ing the contraction phase has been proposed to be useful index of myocardial contractility inde- pendent of loading conditions. 10,11 The purpose of the study was to determine whether the IVA measured by TDI of tricuspid annulus could be used as an index of right ventricular function and its comparison with Sa velocity in patients with COPD. Material and Methods Study Patients In our study, we have enrolled 58 consecutive COPD patients with right heart failure referred 126 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. Vol. 24, No. 2, 2007