Background: Doppler echocardiographic parameters of the middle hepatic vein (MHV)in detecting PHTN. Methods: The study comprised 72 patients who were referred for right heart catheterization (RHC) to our department . All patients underwent conventional transthoracic echocardiography (TTE) the day after RHC and Doppler study of the MHV. Based on RHC and TTE results, Patients were divided in three groups 1: patients with PHTN without significant RV dysfunction (n=25), 2: patients with PHTN with significant RV dysfunction (n=22), 3: patients with normal PAP (n=25). Results: The analysis revealed a significant relationship between A velocity and PHTN among patients with significant RV dysfunction (p=0.033) and PHTN without significant RV dysfunction (p=0.020). At cut-off value of 39.5 cm/s, A velocity could detect PHTN in patient with significant RV dysfunction with sensitivity and specificity of 77.3% and 56.0%, respectively. At cut-off value of 38.5 cm/s, A velocity could detect PHTN without significant RV dysfunction with sensitivity and specificity of 76.0% and 51.0%, respectively. The ROC curve analysis was performed to assess the sensitivity of the hepatic venous systolic filling fraction in detecting normal SPAP in the study population. The area under curve was 0.718. Considering the cut-off value of 0.535 for the hepatic venous systolic filling fraction, the sensitivity and specificity of S/S+D for detecting normal SPAP were 80% and 64%, respectively . Discussion: Doppler echocardiographic parameters of the MHV could be helpful in detecting PHTN. A/S higher than 1 in PHTN was the main finding on HV Doppler assessment in PHT with and without significant RV dysfunction. HV systolic filling fraction more than 0.535 was a sensitive parameter in detecting normal PAP, therefore; HV systolic filling fraction can be used as a screening echocardiographic parameter in ruling out PHTN.

Background: Right Ventricular (RV) failure has a critical role in the onset and progression of clinical symptoms and the prognosis of patients with Mitral Stenosis (MS), but the exact role, effect, and pathophysiology of RV dysfunction in MS is still controversial. In this study, we aimed to evaluate echocardiographic signs of systolic RV dysfunction using Tissue Doppler Imaging (TDI) and Velocity Vector Imaging (VVI) in subjects with severe and very severe MS. Methods: 46 isolated MS cases (23 severe and 23 very severe) and 23 healthy controls were enrolled in this study. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and peak systolic velocity of the tricuspid annulus (S’) using TDI, and RV free wall strain (RVFWS) employing VVI. Furthermore, these values were compared with mitral valve area (MVA) and pulmonary arterial pressure (PAP). Results: TAPSE, FAC, S’, and RVFWS values were substantially declined in MS cases compared with healthy controls. Moreover, PAP values were considerably increased in MS subjects. Additionally, S’ and TAPSE values were significantly lower in very severe MS patients compared with severe patients. Conclusion: RV systolic function deteriorates in patients with severe and very severe MS. It appears that the degree of the severity of MS can proportionately affect the extent of RV dysfunction and some of its echocardiographic markers such as S’ and TAPSE. TDI and VVI can be used as practical early diagnostic methods for RV dysfunction in MS.