MethodEvidence for Early Right Ventricular and Septal Mechanical Activation (Interventricular Dyssynchrony) in Pulmonary Hypertension
Section snippets
Methods
Subjects were enrolled from the pulmonary hypertension clinic and the inpatient cardiology services at the University of Maryland Medical Center. All subjects with PAH had been previously diagnosed with pulmonary hypertension at right heart catheterization. The inclusion criteria for patients with PAH were previous right heart catheterization with mean pulmonary artery pressure >25 mm Hg, age >21 years, and normal sinus rhythm. Patients were excluded for any of the following criteria:
Results
Table 1 presents characteristics of patients with PAH and controls. There were no significant differences between groups in blood pressure or heart rate. Patients with PAH were older then controls; statistical analyses were therefore adjusted for age. No patient had right bundle branch block or left bundle branch block, and the mean QRS was 89.4 ± 8.6 ms (range 76 to 102 ms). Medication use was as follows: sidenafil (n = 14), epoprostenol (n = 5), bosentan (n = 4), treprostinil (n = 2),
Discussion
The principal finding of the study is that chronic PAH is associated with accelerated RV activation in patients with evidence of RV dysfunction and a normal QRS duration. However, despite early RV activation times, the times to Doppler-assessed aortic and pulmonic valve opening were similar in patients with PAH and controls. Although there was no time difference between onset of RV and LV there was evidence of accelerated myocardial systolic activation in the basal RV free wall in patients with
References (9)
- et al.
New method for evaluating left ventricular wall motion by color-coded tissue Doppler imaging: in vitro and in vivo studies
J Am Coll Cardiol
(1995) - et al.
American Society of Echocardiography recommendations for use of echocardiography in clinical trials
J Am Soc Echocardiogr
(2004) The effect of right ventricular dysfunction on left ventricular form and function
Chest
(2001)- et al.
Tissue Doppler imaging and left ventricular dyssynchrony in heart failure
J Card Fail
(2006)
Cited by (0)
Dr. Myung H. Park is a consultant and serves on the speaker's bureau for Actelion Pharmaceuticals, Gilead, and United Therapeutics.