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Early-Diastolic Left Ventricular Lengthening Implies Pulmonary Hypertension-Induced Right Ventricular Decompensation.
MedLine Citation:
PMID:  22875469     Owner:  NLM     Status:  Publisher    
AIMS: In chronic pulmonary hypertension (PH), right ventricular (RV) failure is associated with shortening of the RV free wall (RVFW) beyond pulmonary valve closure temporarily paralleled by pronounced lengthening of the left ventricular free wall (LVFW). We hypothesized that this early-diastolic LVFW lengthening is caused by altered RVFW myofibre function and may therefore serve as non-invasive measure of PH-induced RV (dys)function. METHODS AND RESULTS: In 22 idiopathic pulmonary arterial hypertension (IPAH) patients, 5 chronic thromboembolic pulmonary hypertension (CTEPH) patients and 6 healthy subjects, ventricular volumes and circumferential strains were obtained using magnetic resonance imaging. RV ejection fraction (RVEF) and stroke volume index (RVSVI) were smaller in IPAH and CTEPH patients than in normals (RVEF: 32±12 and 23±19 versus 59±14 %, respectively, both p<0.01; RVSVI: 32±9 and 23±9 versus 47±6 ml/m(2), both p<0.001). LV early-diastolic strain index (LVEDSI), defined as LVFW strain in the period between LVFW and RVFW peak shortening normalized for total systolic LVFW shortening, was larger in IPAH and CTEPH patients (0.52±0.33 and 0.55±0.40, both p<0.01) than in normals (0.03±0.03). LVEDSI correlated negatively with RVEF (R=-0.74, p<0.0001) and RVSVI (R=-0.69, p<0.0001). Three multi-scale computer simulations of PH (all mPAP=55mmHg) with complete, incomplete, and no structural adaptation of ventricular walls to local myofibre load showed that LVEDSI increased with deficiency of cardiac adaptation to PH (0.01, 0.52 and 0.84, respectively). CONCLUSION: Early-diastolic LV lengthening reflects inadequate structural adaptation of the RVFW to increased myofibre load and is therefore a useful, non-invasive and easily obtainable predictor of PH-induced RV dysfunction.
Joost Lumens; Theo Arts; J Tim Marcus; Anton Vonk-Noordegraaf; Tammo Delhaas
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-8
Journal Detail:
Title:  Cardiovascular research     Volume:  -     ISSN:  1755-3245     ISO Abbreviation:  Cardiovasc. Res.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0077427     Medline TA:  Cardiovasc Res     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht , Maastricht University, Maastricht, The Netherlands.
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