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Altered Early Left Ventricular Diastolic Wall Velocities in Pulmonary Hypertension: A Tissue Doppler Study
Author(s) -
LópezCandales Angel,
Bazaz Raveen,
Edelman Kathy,
Gulyasy Beth
Publication year - 2009
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.2009.00944.x
Subject(s) - diastole , cardiology , medicine , doppler imaging , interventricular septum , basal (medicine) , pulmonary hypertension , ejection fraction , doppler echocardiography , sinus rhythm , heart failure , blood pressure , ventricle , atrial fibrillation , insulin
Background: Left ventricular diastolic dysfunction (LVDD) is known to occur in severe chronic pulmonary hypertension (PH); however, the mechanism(s) remains unclear. Methods: Tissue Doppler imaging (TDI) was used to track early (E) diastolic signals of basal and mid portions of the interventricular septum (IS) and LV free wall (LVFw) in 20 patients (60 ± 8 years) with documented LVDD without PH and in 30 patients (60 ± 11 years) with known chronic PH. All subjects were in normal sinus rhythm and had normal LV ejection fraction. Results: PH patients had lower early (E) wave velocities in basal IS (–4.2 ± 1.9 vs. –5.9 ± 1.2 cm/sec; P < 0.001), distal IS (–2.6 ± 2.6 vs. –4.2 ± 1.1 cm/sec; P < 0.01), and basal LVFw (–5.2 ± 1.7 vs. –6.5 ± 1.2 cm/sec; P < 0.01) than patients with LVDD and no PH. Finally, worsening PH distorts the entire IS diastolic tracing resulting in asynchronous diastolic signals. Conclusions: The presence of PH not only decreases IS early (E) wave diastolic velocity generation but also distorts the entire pattern of IS diastolic relaxation when compared to patients with typical LVDD and no PH. Further studies are now needed to assess the full effect of PH on LV diastole and how this influences clinical outcomes. (ECHOCARDIOGRAPHY, Volume 26, November 2009)