Chest
ChestInterventricular Mechanical Asynchrony Due To Right Ventricular Pressure Overload in Pulmonary Hypertension Plays an Important Role in Impaired Left Ventricular Filling
Section snippets
Materials and Methods
Fifty-nine patients with idiopathic PAH (mean [± SD] pulmonary artery pressure, 52 ± 16 mm Hg) and 24 healthy control subjects were measured by means of MRI (1.5 T Sonata system; Siemens; Erlangen, Germany). To investigate RV and LV systolic contraction time, seven patients were measured by means of measuring myocardial tagging of the RV and LV. By means of harmonic phase strain analysis, the time from ECG R-wave trigger to peak shortening (Tpeak) was calculated as a parameter for systolic
Results
For the seven patients studied with tagging, the mean Tpeak values for the RV inferior, lateral, and anterior regions were 322 ± 68, 366 ± 57, and 364 ± 53 ms, respectively. For the LV lateral region, the mean Tpeak was 266 ± 54 ms. Thus, the mean Tpeak for the RV lateral region was 100 ± 43 ms later than that for the LV lateral value (p < 0.001), and the mean Tpeak for the RV anterior region was 98 ± 38 ms later than that for the LV lateral region (p < 0.001). In comparison with the control
Discussion
These results show that in PAH, there is a significant interventricular asynchrony due to a prolonged RV systolic contraction time in comparison to the LV. This is probably caused by a decrease of electrical conductivity over the RV, a high prestretch of the RV myocardial fibers, and the large force these fibers must generate to shorten. This ventricular asynchrony impedes LV diastolic filling, causing a lowered LV end-diastolic volume.
Underfilling of the LV can be explained in two ways. First,
References (6)
- et al.
Impaired left ventricular filling due to right ventricular pressure overload in primary pulmonary hypertension: noninvasive monitoring using MRI
Chest
(2001) - et al.
Effects of volume loading during experimental acute pulmonary embolism
Circulation
(1989) - et al.
Quantitative assessment of independent contributions of pericardium and septum to direct ventricular interaction
Am J Physiol
(1989)
Cited by (43)
Early implementation of renal replacement therapy after lung transplantation does not impair long-term kidney function in patients with idiopathic pulmonary arterial hypertension
2022, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :This fact is supported by studies showing that higher central venous pressure is associated with reduced eGFR.17,18 On the other hand, left ventricular output is reduced because of decreased left atrial filling and mechanical compression by right ventricular enlargement.19-22 As a consequence, renal blood flow decreases and the activation of neurohormonal mechanisms further worsens kidney function.
Right ventricular adaptation to pressure-overload: Differences between chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertension
2021, Journal of Heart and Lung TransplantationApparent Ventricular Dysfunction in Elite Young Athletes: Another Form of Cardiac Adaptation of the Athlete's Heart
2019, Journal of the American Society of EchocardiographyImplications of cardiac variability with cardiovascular magnetic resonance imaging for calculating trial sample size in pulmonary arterial hypertension
2018, International Journal of Cardiology
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).