BACKGROUND: Pulmonary arterial hypertension (PAH) is characterized by pulmonary vascular remodeling and right heart failure. The right (RV) and left ventricles (LV) do not function in isolation, sharing a common pericardial sac and interventricular septum. We sought to define the clinical and prognostic significance of ventricular interdependence in PAH and its association with LV filling patterns through speckle-tracking strain echocardiography. METHODS AND RESULTS: Echocardiography was performed in 71 adults with a new diagnosis of PAH. To analyze LV and RV function separately, we measured peak systolic longitudinal and circumferential strain of the LV and RV. Survival was assessed >2 years. Patients had dilated right-sided chambers (right atrial volume index, 44 ± 19 mL/m(2); RV end-diastolic area, 34 ± 9 cm(2)), and reduced RV function (RV fractional area change, 28 ± 12%). Speckle-tracking echocardiography revealed significant reductions in RV free wall peak systolic strain (-15 ± 3%). Despite normal LV size and normal conventional measures of LV systolic function (end-diastolic dimension, 42 ± 6 mm; ejection fraction, 65 ± 8%; cardiac index, 2.6 ± 0.8 L/min per m(2)), patients had reduced LV free wall systolic strain (-15 ± 3%). Decreased LV free wall systolic strain was associated with a delayed relaxation mitral inflow Doppler pattern, P=0.0002. During 2-year follow-up, 19 patients (27%) died. LV strain was associated with increased mortality (unadjusted hazard ratio, 2.40 per 5% decrease in LV free wall strain, 1.22-4.68), which remained significant when adjusted for age, sex, World Health Organization functional class, and PAH pathogenesis (hazard ratio, 3.11, 1.38-7.20). CONCLUSIONS: The pressure loading in PAH results in geometric alterations and functional decline of the RV, with marked reduction in RV systolic strain. Despite preservation of LV ejection fraction, LV systolic strain was also reduced and associated with early mortality, highlighting the significance of ventricular interdependence in PAH.
BACKGROUND:Pulmonary arterial hypertension (PAH) is characterized by pulmonary vascular remodeling and right heart failure. The right (RV) and left ventricles (LV) do not function in isolation, sharing a common pericardial sac and interventricular septum. We sought to define the clinical and prognostic significance of ventricular interdependence in PAH and its association with LV filling patterns through speckle-tracking strain echocardiography. METHODS AND RESULTS: Echocardiography was performed in 71 adults with a new diagnosis of PAH. To analyze LV and RV function separately, we measured peak systolic longitudinal and circumferential strain of the LV and RV. Survival was assessed >2 years. Patients had dilated right-sided chambers (right atrial volume index, 44 ± 19 mL/m(2); RV end-diastolic area, 34 ± 9 cm(2)), and reduced RV function (RV fractional area change, 28 ± 12%). Speckle-tracking echocardiography revealed significant reductions in RV free wall peak systolic strain (-15 ± 3%). Despite normal LV size and normal conventional measures of LV systolic function (end-diastolic dimension, 42 ± 6 mm; ejection fraction, 65 ± 8%; cardiac index, 2.6 ± 0.8 L/min per m(2)), patients had reduced LV free wall systolic strain (-15 ± 3%). Decreased LV free wall systolic strain was associated with a delayed relaxation mitral inflow Doppler pattern, P=0.0002. During 2-year follow-up, 19 patients (27%) died. LV strain was associated with increased mortality (unadjusted hazard ratio, 2.40 per 5% decrease in LV free wall strain, 1.22-4.68), which remained significant when adjusted for age, sex, World Health Organization functional class, and PAH pathogenesis (hazard ratio, 3.11, 1.38-7.20). CONCLUSIONS: The pressure loading in PAH results in geometric alterations and functional decline of the RV, with marked reduction in RV systolic strain. Despite preservation of LV ejection fraction, LV systolic strain was also reduced and associated with early mortality, highlighting the significance of ventricular interdependence in PAH.
Authors: Gabriela Querejeta Roca; Patricia Campbell; Brian Claggett; Ali Vazir; Debbie Quinn; Scott D Solomon; Amil M Shah Journal: Eur J Heart Fail Date: 2014-11-04 Impact factor: 15.534
Authors: Michal Schäfer; D Dunbar Ivy; Steven H Abman; Alex J Barker; Lorna P Browne; Brian Fonseca; Vitaly Kheyfets; Kendall S Hunter; Uyen Truong Journal: Circ Cardiovasc Imaging Date: 2017-02 Impact factor: 7.792
Authors: Yin Yin Chen; Hong Yun; Hang Jin; De Hong Kong; Yu Liang Long; Cai Xia Fu; Shan Yang; Meng Su Zeng Journal: Int J Cardiovasc Imaging Date: 2017-03-17 Impact factor: 2.357
Authors: Michael Morcos; Philip J Kilner; David J Sahn; Harold I Litt; Emanuela R Valsangiacomo-Buechel; Florence H Sheehan Journal: Int J Cardiovasc Imaging Date: 2017-07-01 Impact factor: 2.357
Authors: Dale A Burkett; Cameron Slorach; Sonali S Patel; Andrew N Redington; D Dunbar Ivy; Luc Mertens; Adel K Younoszai; Mark K Friedberg Journal: Circ Cardiovasc Imaging Date: 2016-09 Impact factor: 7.792
Authors: Kimberly Kallianos; Gabriel C Brooks; Kanae Mukai; Florent Seguro de Carvalho; Jing Liu; David M Naeger; Teresa De Marco; Karen G Ordovas Journal: Acad Radiol Date: 2017-08-31 Impact factor: 3.173
Authors: Dale A Burkett; Cameron Slorach; Sonali S Patel; Andrew N Redington; D Dunbar Ivy; Luc Mertens; Adel K Younoszai; Mark K Friedberg Journal: Circ Cardiovasc Imaging Date: 2015-08 Impact factor: 7.792