Prevalence and Prognostic Value of Left Ventricular Diastolic Dysfunction in Idiopathic and Heritable Pulmonary Arterial Hypertension

Tonelli, Adriano R.; Plana, Juan Carlos; Heresi, Gustavo A.; Dweik, Raed A.

doi:10.1378/chest.11-1903

Cited by 72 publications

(72 citation statements)

References 31 publications

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“…The association of a delayed relaxation mitral inflow Doppler pattern with mortality has been previously reported in PAH, 29,30 and was confirmed in our study. We demonstrated a greater 2-year all-cause mortality among patients with a delayed relaxation mitral inflow pattern (55%; 11/20) compared with those with normal LV diastolic filling (16%; 8/51; P=0.0002).…”

Section: Predictors Of Overall Mortalitysupporting

confidence: 91%

“…RV systolic dysfunction is a recognized feature of PAH with the severity of RV dysfunction correlating with symptoms, mortality, and 2D longitudinal strain, a sensitive quantitative measure of contractility emerging as a potent measure of RV 18,19,30 Here, we used strain imaging to evaluate whether, in the setting of normal LV ejection fraction and LV filling pressure in PAH, impairment in LV mechanical function was present in PAH and whether it was of clinical significance.…”

Section: Discussionmentioning

confidence: 99%

“…18,19,30 Here, we used strain imaging to evaluate whether, in the setting of normal LV ejection fraction and LV filling pressure in PAH, impairment in LV mechanical function was present in PAH and whether it was of clinical significance.…”

Section: Discussionmentioning

confidence: 99%

“…Other groups have also noted similar findings of LV diastolic dysfunction in patients with PAH, as demonstrated by impaired LV relaxation. 30 Proposed mechanisms include an early diastolic left-to-right septal displacement with reduced LV compliance, 39,40 decreased LV torsion with delayed diastolic untwisting, 18 increased RV tension leading to prolonged myocardial shortening with impairment of RV systole and LV diastole, 19,41 RV conduction slowing and action potential prolongation with resultant ventricular dyssynchrony and diastolic delay, 42 and impaired LV filling through preload reduction. 43 Indeed, patients tended to have a reduction in the early peak diastolic tissue velocities of the mitral annulus (E), although neither E′ velocity nor E/E′ ratio was different between those with or without severe LV systolic strain reduction.…”

Section: Discussionmentioning

confidence: 99%

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Impaired Left Ventricular Mechanics in Pulmonary Arterial Hypertension

Hardegree

Sachdev

Fenstad

et al. 2013

Circ: Heart Failure

114

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P ulmonary arterial hypertension (PAH) is characterized by pulmonary vascular remodeling, right heart failure, and reduced survival.1 Both symptoms and extent of right heart failure predict mortality. [2][3][4] Measures of RV filling pressure and systolic function have been shown to correlate with clinical disease progression and survival. 5-8 Clinical Perspective on p 755Right ventricular (RV) contraction is a complex process related to a variety of actions, the predominant being longitudinal motion because of the arrangement of ventricular myofibrils.9-12 RV systolic strain assessment by speckle-tracking echocardiography is an angle-independent sensitive measure of RV contraction shown to correlate with clinical symptoms and invasive hemodynamic measures and is predictive of disease progression and mortality. [13][14][15][16][17] PAH is a disease of the pulmonary circulation with resultant effects on the right heart. Conceptually, left heart anatomy and function should be normal in patients with PAH. However, the RV and left ventricle (LV) do not function in isolation, sharing a common pericardial sac and interventricular septum. 18 A delayed relaxation mitral inflow Doppler pattern on echocardiography (a feature seen in normal or low filling pressures and diastolic dysfunction) has been linked to severity of disease in PAH; however, it is unclear whether this Doppler pattern reflects impaired LV filling because of reduced RV output or intrinsic LV dysfunction. 19 We sought to define the clinical and prognostic significance of ventricular interdependence 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...

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Section: Predictors Of Overall Mortalitysupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Impaired Left Ventricular Mechanics in Pulmonary Arterial Hypertension

Hardegree

Sachdev

Fenstad

et al. 2013

Circ: Heart Failure

114

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“…In addition, bisoprolol has been found to delay RV failure and preserve RV function in experimental pulmonary hypertension [11]. Patients with PAH are also known to have a high prevalence of left ventricular diastolic dysfunction [12], where β blockade may produce a salutary effect. Thus, there is a rationale for a potential benefit of β-blocker therapy in these patients.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of β-blocker use in pulmonary arterial hypertension: a propensity-matched analysis

et al. 2015

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The utility and safety of β-blockers in pulmonary hypertension is controversial. Anecdotal reports suggest that β-blockers may be harmful in these patients. The aim of our study was to evaluate outcomes of β-blocker use in pulmonary hypertension.We reviewed patients from our pulmonary hypertension registry between 2000 and 2011. Patients who continued to use β-blockers were compared to those who never used β-blockers for all-cause mortality, time to clinical worsening events, defined as death, lung transplantation and hospitalisation due to pulmonary hypertension. We also evaluated the effect of β-blockers on 6-min walking distance and New York Heart Association (NYHA) functional class.133 patients used β-blockers and 375 patients never used β-blockers. Mean±SD age was 57±16 years and the median follow-up period was 78 months. Propensity-matched analysis showed that the adjusted odds ratio (95% CI) for mortality with β-blocker use was 1.13 (0.69-1.82) and for clinical worsening events was 0.96 (0.55-1.68). No significant difference was noted in probability of survival and time to clinical worsening events. Patients on β-blockers walked a shorter distance on follow-up 6 min walk test; follow-up NYHA class was similar between groups.Pulmonary hypertension patients receiving β-blockers had a similar survival and time to clinical worsening events compared to patients not receiving them. Functional outcomes were similar, although β-blocker use was associated with a tendency towards shorter walking distance. @ERSpublications β-blocker use does not affect survival, symptom worsening or functional capacity in pulmonary hypertension

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Paradoxical septal motion: A diagnostic approach and clinical relevance

Clancy

McLean

Slama

et al. 2018

Australas J Ultrason Med

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Abnormal septal motion (commonly referred to as septal bounce) is a common echocardiographic finding that occurs with several conditions, including the following: mitral stenosis, left bundle branch block, pericardial syndromes and severe pulmonary hypertension. We explore the subtle changes that occur on M-mode imaging of the septum, other associated echocardiographic features, the impact of inspiratory effort on septal motion and relevant clinical findings. Finally, we discuss the impact of abnormal septal motion on cardiac form and function, proposing there is a clinically significant impact on biventricular filling and ejection.

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Prevalence and Prognostic Value of Left Ventricular Diastolic Dysfunction in Idiopathic and Heritable Pulmonary Arterial Hypertension

Cited by 72 publications

References 31 publications

Impaired Left Ventricular Mechanics in Pulmonary Arterial Hypertension

Impaired Left Ventricular Mechanics in Pulmonary Arterial Hypertension

Outcomes of β-blocker use in pulmonary arterial hypertension: a propensity-matched analysis

Paradoxical septal motion: A diagnostic approach and clinical relevance

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