Chest
ORIGINAL RESEARCHPULMONARY VASCULAR DISEASERight Ventricular Diastolic Dysfunction and the Acute Effects of Sildenafil in Pulmonary Hypertension Patients
Section snippets
Patients
Twenty-five PH patients with normal renal function and 11 nonsmoking, healthy control subjects were studied. Eighteen patients were referred to our center for the initial evaluation of PH, and seven patients were referred for the evaluation of treatment effects (three patients were receiving epoprostenol, and four patients were receiving bosentan). The different etiologies of PH were distributed as follows: idiopathic pulmonary arterial hypertension (PAH) [n = 18]; PAH related to the limited
Results
There was no difference between the PH patients and control subjects with respect to mean age (PH patients, 49.1 ± 15.3 years; control subjects, 46.5 ± 11.4 years; t34 = 0.59 [t test]; p = 0.56) and the proportion of men/women (PH patients, 5/20; control subjects, 3/8; p = 0.41 [Fisher exact test]). Patient characteristics and hemodynamics are summarized in Table 1. The majority of patients were female and in New York Heart Association functional class III. Hemodynamics yielded the
Discussion
This study showed the following: (1) in PH patients, RV diastolic function, quantified by RV IVRT, peak filling rate, and filling pattern, was significantly impaired compared to control subjects; (2) diastolic function was related to RV mass and afterload, and improved by reducing RV afterload; and (3) RV diastolic dysfunction was related to parameters of disease severity.
Conclusion
RV diastolic function is impaired in PH patients, which is related to RV mass and the extent of RV afterload, and improves by reducing RV afterload. The correlations that were found between diastolic function and well-known prognostic parameters in PH patients showed that diastolic function is most impaired in patients with severe disease.
References (27)
- et al.
Mechanical loads and the isovolumic and filling indices of left ventricular relaxation
Prog Cardiovasc Dis
(1990) - et al.
Evaluation of right ventricular early diastolic filling by cine nuclear magnetic resonance imaging in patients with hypertrophic cardiomyopathy
J Am Coll Cardiol
(1991) - et al.
Doppler echocardiographic index for assessment of global right ventricular function
J Am Soc Echocardiogr
(1996) - et al.
Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension
Chest
(2006) - et al.
New predictors of outcome in idiopathic pulmonary arterial hypertension
Am J Cardiol
(2005) - et al.
Assessment of right ventricular diastolic and systolic function in patients with dilated cardiomyopathy using cine magnetic resonance imaging
Am Heart J
(1991) - et al.
The evaluation of pulmonary hypertension using right ventricular myocardial isovolumic relaxation time
J Am Soc Echocardiogr
(2005) Diastolic dysfunction in congestive heart failure
N Engl J Med
(1991)- et al.
Diastolic dysfunction as a cause of heart failure
J Am Coll Cardiol
(1993) - et al.
Diagnosis and differential assessment of pulmonary arterial hypertension
J Am Coll Cardiol
(2004)
Effect of inhaled iloprost plus oral sildenafil in patients with primary pulmonary hypertension
Circulation
Combination therapy with oral sildenafil and inhaled iloprost for severe pulmonary hypertension
Ann Intern Med
MRI evaluation of right ventricular pressure overload in chronic obstructive pulmonary disease
J Magn Reson Imaging
Cited by (128)
Traditional and Advanced Echocardiographic Evaluation in Chronic Obstructive Pulmonary Disease: The Forgotten Relation
2024, American Journal of CardiologyRight Ventricular Myocardial Stiffness and Relaxation Components by Kinematic Model-Based Transtricuspid Flow Analysis in Children and Adolescents with Pulmonary Arterial Hypertension
2019, Ultrasound in Medicine and BiologyCitation Excerpt :Right ventricular diastolic dysfunction determines ventricular performance and patient outcomes for many conditions. Moreover, this dysfunction may precede the apparent systolic dysfunction (Dernellis 2001; Gan et al. 2007; Leeuwenburgh et al. 2002; Rudski et al. 2010). Overall, we believe that our current findings indicate the great clinical implications for this method with respect to the management of PAH patients.
Mr. Gan was financially supported by the Netherlands Organisation for Scientific Research (NWO), Mozaiek grant, project No. 017.001.154.
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.