Doppler indices of delayed LV relaxation can be detected in the presence of normal or supranormal EF but are independently related to impaired MS. A less severely abnormal relaxation, however, can be also detected in the presence of normal midwall function, independent of LV geometry and load. Thus, diastolic abnormalities may occur before systolic dysfunction even when it is measured at the midwall.
In patients with chronic PH, RA size and systolic function significantly increase and parallel signs of activation of the Frank-Starling mechanism in both right chambers. The magnitude of these phenomena is positively related to PASP levels.
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