Chest
Volume 128, Issue 6, Supplement, December 2005, Pages 628S-630S
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Interventricular Mechanical Asynchrony Due To Right Ventricular Pressure Overload in Pulmonary Hypertension Plays an Important Role in Impaired Left Ventricular Filling

https://doi.org/10.1378/chest.128.6_suppl.628SGet rights and content

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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,

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