Evaluation of left ventricular diastolic function profile in patients with pulmonary hypertension due to heart failure with preserved ejection fraction
Abstract:Background
Echocardiography plays an important role in the diagnostic work up of heart failure with preserved ejection fraction (HFpEF). We sought to determine the left ventricular (LV) diastolic profile by echocardiography in patients diagnosed with pulmonary hypertension (PH) due to PH-HFpEF.
Hypothesis
The study of LV diastolic function by echocardiography has limitations in patients with HFpEF and PH, and certain LV diastolic determinations convey a worse prognosis.
Methods
We included patients with po… Show more
“…Increasing evidences showed that left atrial dysfunction was a positive cause of symptoms and disease progression [41]. In order to overcome the increase of left atrial pressure and volume caused by LVDD, previous studies on left atrial dysfunction disclosed that the P-V loop of the left atrium had changed [33,34], as shown in Fig. 7.…”
Section: Model For Right Ventricular Compensationmentioning
confidence: 99%
“…In the early stage of this PH, there may be no significant change in PVR. However, as the disease progresses, it eventually damages the pulmonary blood vessels, resulting in an increase in PVR [ 34 ]. Fig.…”
Section: Simulations For Four Typical Cases Of Phmentioning
confidence: 99%
“…Melenovsky et al [ 33 ] observed that the PVR increased twice with increasing pressure in a PH case caused by heart failure. Raeisi-Giglou et al [ 34 ] found from clinical observation that PVR became greater than normal in patients with LVDD. The previous study [ 22 ] showed that the mean pulmonary artery pressure P m and compliance C show a relationship, which fit an exponential model, where g c and h c are the constant coefficients.…”
Section: Simulations For Four Typical Cases Of Phmentioning
Pulmonary hypertension (PH) presents unusual hemodynamic states characterized by abnormal high blood pressure in pulmonary artery. The objective of this study is to simulate how the hemodynamics develops in typical PH cases without treatment. A lumped-parameter circuit platform of human circulation system is set up to simulate hemodynamic abnormalities of PH in different etiologies and pathogenesis. Four typical cases are considered, which are distal pulmonary artery stenosis, left ventricular diastolic dysfunction, ventricular septal defect, and mitral stenosis. The authors propose regulation laws for chambers and vessels to adapt the abnormal hemodynamic conditions for each PH case. The occurrence and development of each PH case are simulated over time using the lumped-parameter circuit platform. The blood pressure, blood flow, pressure-volume relations for chambers and vessels are numerically calculated for each case of PH progression. The model results could be a quite helpful to understand the hemodynamic mechanism of typical PHs.
“…Increasing evidences showed that left atrial dysfunction was a positive cause of symptoms and disease progression [41]. In order to overcome the increase of left atrial pressure and volume caused by LVDD, previous studies on left atrial dysfunction disclosed that the P-V loop of the left atrium had changed [33,34], as shown in Fig. 7.…”
Section: Model For Right Ventricular Compensationmentioning
confidence: 99%
“…In the early stage of this PH, there may be no significant change in PVR. However, as the disease progresses, it eventually damages the pulmonary blood vessels, resulting in an increase in PVR [ 34 ]. Fig.…”
Section: Simulations For Four Typical Cases Of Phmentioning
confidence: 99%
“…Melenovsky et al [ 33 ] observed that the PVR increased twice with increasing pressure in a PH case caused by heart failure. Raeisi-Giglou et al [ 34 ] found from clinical observation that PVR became greater than normal in patients with LVDD. The previous study [ 22 ] showed that the mean pulmonary artery pressure P m and compliance C show a relationship, which fit an exponential model, where g c and h c are the constant coefficients.…”
Section: Simulations For Four Typical Cases Of Phmentioning
Pulmonary hypertension (PH) presents unusual hemodynamic states characterized by abnormal high blood pressure in pulmonary artery. The objective of this study is to simulate how the hemodynamics develops in typical PH cases without treatment. A lumped-parameter circuit platform of human circulation system is set up to simulate hemodynamic abnormalities of PH in different etiologies and pathogenesis. Four typical cases are considered, which are distal pulmonary artery stenosis, left ventricular diastolic dysfunction, ventricular septal defect, and mitral stenosis. The authors propose regulation laws for chambers and vessels to adapt the abnormal hemodynamic conditions for each PH case. The occurrence and development of each PH case are simulated over time using the lumped-parameter circuit platform. The blood pressure, blood flow, pressure-volume relations for chambers and vessels are numerically calculated for each case of PH progression. The model results could be a quite helpful to understand the hemodynamic mechanism of typical PHs.
“…Several studies have failed to find an echocardiographic profile in patients with HFpEF that is diagnostic of PH-HFpEF. Studies by Raeisi-Giglou and colleagues indicate that a mere 41% of patients with PH-HFpEF by RHC had LV diastolic dysfunction on echocardiography (48). Thus, while echocardiography may be sufficient to diagnose diastolic dysfunction, it is often insufficient to diagnose PH in the setting of HFpEF and an invasive RHC remains a necessary diagnostic tool.…”
Section: Non-invasive Measures Of Ph-hfpefmentioning
Heart failure with preserved ejection fraction (HFpEF) is defined as clinical features of heart failure, ideally with biomarker evidence such as elevated plasma natriuretic peptide levels, in the setting of an ejection fraction (EF) greater than 50% and imaging evidence of diastolic left ventricular dysfunction [1,2]. In the absence of cardiac imaging or invasive hemodynamics, this is a clinical syndrome that is often indistinguishable from heart failure with reduced ejection fraction (HFrEF). HFpEF and HFrEF present with a cadre of comparable signs and symptoms including jugular venous distention, pulmonary rales on auscultation, breathlessness, orthopnea, exercise intolerance, exertional dyspnea, fatigue and peripheral edema. HFpEF accounts for at least half of all diagnoses of heart failure [1,2]. Pulmonary hypertension (PH) is a common complication of HFpEF that is linked to worse disease morbidity and mortality. In fact, mortality has been linked to increases in the intrinsic pulmonary vascular resistance in the setting of increased left ventricular end diastolic pressure, characterized hemodynamically by rises in the transpulmonary pressure gradient, pulmonary vascular resistance or diastolic pressure gradient. Despite being the most common form of PH, there are no approved therapies for the treatment of PH secondary to HFpEF. This review will summarize the hemodynamic classifications of PH in the setting of HFpEF, mechanisms of disease, the potential contribution of pulmonary vascular disease to poor outcomes in patients with HFpEF, and new approaches to therapy.
“…PH is a hemodynamic condition caused by a variety of diseases of the lungs and heart, or other systemic diseases ( 5 – 8 ). RHC remains the primary standard for the evaluation of PH, with the ability to exclude left-to-right cardiac shunt and other severe left-sided heart conditions ( 9 , 10 ). However, RHC is invasive and has potentially fatal complications ( 11 ).…”
The present study aimed to evaluate hemodynamics and right ventricular function in patients with pulmonary hypertension (PH) using transthoracic echocardiography and to compare these results with measurements obtained using right-sided heart catheterization (RHC). A total of 75 patients with PH were examined using echocardiography and RHC. Patients were divided into the following two groups according to their difference between SPAPecho and SPAPRHC measurement: The overestimated group and underestimated group. The overestimated group included the subgroups groupover-A (difference <20 mmHg) and groupover-B (difference ≥20 mmHg), and the underestimated group included groupunder-A (absolute value of the difference <20 mmHg) and groupunder-B (absolute value of the difference ≥20 mmHg). SPAPecho measurements were revealed to be significantly positively correlated with SPAPRHC measurements (r=0.794; P<0.01). Among all echocardiographic measurements, only tricuspid annular plane systolic excursion (TAPSE) was significantly different between groups; it was increased in groupover-A and groupunder-A compared with groupover-B (P<0.01). Although SPAP measurements obtained using echocardiography were significantly positively correlated with those obtained using RHC, a high proportion of overestimation or underestimation of SPAP by echocardiography remained.
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