Document Detail


Ventricular geometry, strain, and rotational mechanics in pulmonary hypertension.
MedLine Citation:
PMID:  20048214     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We tested the hypothesis that right ventricular (RV) pressure overload affects RV function and further influences left ventricular (LV) geometry, which adversely affects LV twist mechanics and segmental function.
METHODS AND RESULTS: Echocardiographic images were prospectively acquired in 44 patients (age, 46+/-12 years; 82% women) with evidence of pulmonary hypertension (estimated pulmonary artery systolic pressure, 71+/-23 mm Hg) and in 44 age- and gender-matched healthy subjects. Patients with intrinsic LV diseases were excluded. RV lateral wall longitudinal strain (LS) and interventricular septal (IVS) LS were reduced in the pulmonary hypertension group compared with control subjects (-15.9+/-7.6% versus -25.5+/-6.1%, P<0.001; and -17.3+/-4.4% versus -20.2+/-3.9%, P=0.002, respectively), whereas LV lateral wall LS was preserved. RV lateral wall LS and IVS LS, but not LV lateral wall LS, correlated with pulmonary artery systolic pressure (r=0.56, P<0.01; r=0.32, P<0.01) and LV eccentricity index (r=0.57, P<0.01; r=0.57, P<0.01). IVS and LV lateral wall circumferential strain (CS) were both reduced in the pulmonary hypertension group. Although IVS CS and LV lateral wall CS correlated with pulmonary artery systolic pressure and LV eccentricity index, after adjustment of CS for LV eccentricity index, differences between groups persisted for IVS CS (P<0.01) but not LV lateral wall CS (P=0.09). LV torsion was decreased in patients with pulmonary hypertension compared with control subjects (9.6+/-4.9 degrees versus 14.7+/-4.9 degrees , P<0.001). LV torsion inversely correlated with pulmonary artery systolic pressure (r=-0.39, P<0.01) and LV eccentricity index (r=-0.3, P<0.01). LV untwisting rates were similar in both groups (P=0.7).
CONCLUSIONS: Chronic RV pressure overload directly affects RV longitudinal systolic deformation. RV pressure overload further influences IVS and LV geometry, which impairs LV torsion and segmental LS and CS, more for the IVS than for the free wall of the LV.
Authors:
Sarinya Puwanant; Margaret Park; Zoran B Popović; W H Wilson Tang; Samar Farha; Deepa George; Jacqueline Sharp; Jirapa Puntawangkoon; James E Loyd; Serpil C Erzurum; James D Thomas
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2010-01-04
Journal Detail:
Title:  Circulation     Volume:  121     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-19     Completed Date:  2010-03-18     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  259-66     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Biomechanics
Case-Control Studies
Electrocardiography
Female
Heart Ventricles / pathology,  physiopathology*
Humans
Hypertension, Pulmonary / pathology,  physiopathology*
Male
Middle Aged
Prospective Studies
Pulmonary Artery / physiopathology
Ventricular Dysfunction, Left / pathology,  physiopathology
Ventricular Dysfunction, Right / pathology,  physiopathology
Grant Support
ID/Acronym/Agency:
HL60917/HL/NHLBI NIH HHS; R01 HL060917/HL/NHLBI NIH HHS; R01 HL060917-11/HL/NHLBI NIH HHS; UL1 RR024989/RR/NCRR NIH HHS; UL1 RR024989-03/RR/NCRR NIH HHS; UL1-RR024989/RR/NCRR NIH HHS
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