Regional contribution to ventricular stroke volume is affected on the left side, but not on the right in patients with pulmonary hypertension

Abstract

59 ± 9 %, p < 0.0001 and p < 0.01, respectively). This decrease did not differ in patient with ejection fraction (eF) >50 % and <50 % (p = 0.5) and was compensated for by increased lV lateral contribution to lVSV in patients (49 ± 13 % vs. 37 ± 7 %, p = 0.001). Septal motion contributed less to lVSV in patients (5 ± 8 %) compared to controls (8 ± 4 %, p = 0.05). rV aVPD was lower in patients (12.0 ± 3.6 mm vs. 21.8 ± 2.2 mm, p < 0.0001) but longitudinal and lateral contribution to rVSV did not differ between patients (78 ± 17 % and 29 ± 16 %) and controls (79 ± 9 % and 31 ± 6 % p = 0.7 for both) explained by increased rV cross sectional area in patients. lV function is affected in patients with PH despite preserved global lV function. The decreased longitudinal contribution and increased lateral contribution to lVSV was not seen in the rV, contrary to previous findings in patients with volume loaded RVs. Abstract To develop more sensitive measures of impaired cardiac function in patients with pulmonary hypertension (PH), since detection of impaired right ventricular (rV) function is important in these patients. With the hypothesis that a change in septal function in patients with PH is associated with altered longitudinal and lateral function of both ventricles, as a compensatory mechanism, we quantified the contributions of these parameters to stroke volume (SV) in both ventricles using cardiac magnetic resonance (CMr). Seventeen patients (10 females) evaluated for PH underwent right heart catheterization (rHC) and CMr. CMr from 33 healthy adults (13 females) were used as controls. left ventricular (lV) atrioventricular plane displacement (aVPD) and corresponding longitudinal contribution to lVSV was lower in patients (10.8 ± 3.2 mm and 51 ± 12 %) compared to controls (16.6 ± 1.9 mm and 1 3 1244 int J Cardiovasc imaging (2016) 32:1243-1253 trols. The control group has been described in a previous study [11]. The regional ethical review board approved the study and written informed consent was obtained from all patients and healthy volunteers prior to CMr examination. Keywords Right heart catheterizationinvasive measurements were obtained during rHC with a triple-lumen Swan-ganz catheter in supine position and in local anesthesia. Pressures of pulmonary artery (PaP), right atrium, right ventricle and pulmonary artery wedge as well as cardiac output using thermodilution were measured. Precapillary PH was characterized by elevated mean pulmonary arterial pressure (mPaP) ≥25 mmHg and pulmonary artery wedge pressure ≤15 mmHg at normal or reduced cardiac output. Systemic pressure was available using a cuff and sphygmomanometer. Cardiac magnetic resonance imagingImage acquisition all subjects underwent CMr imaging in the supine position and images were acquired during end-expiratory breath-hold covering the entire heart, including both ventricles and atria. a 1.5 Tesla magnetic resonance imaging scanner was used for all studies (Philips achieva, Best, The netherlands). Steady state free precession cine images were ...

Isolated pulmonary regurgitation causes decreased right ventricular longitudinal function and compensatory increased septal pumping in a porcine model

“…This is supported by previous observations in patients with pulmonary arterial hypertension (PAH). These patients exhibit LV underfilling and an intact septal contribution to LVSV . Contrarily to our observation, LV longitudinal pumping in PAH is, however, reduced, suggesting that the increased longitudinal contribution to LVSV in PR may in part be a compensation for lost septal SV due to paradoxical septal movement .…”

“…These patients exhibit LV underfilling and an intact septal contribution to LVSV. 31 Contrarily to our observation, LV longitudinal pumping in PAH is, however, reduced, suggesting that the increased longitudinal contribution to LVSV in PR may in part be a compensation for lost septal SV due to paradoxical septal movement. 31 Despite our speculative understanding of the pathophysiological mechanisms underlying LV pumping adaptation to PR, it is worth stressing the fundamental observation that the LV has the capacity to adapt its pumping mechanics to RV impairment and isolated loss of LV function, that is septal pumping, and maintain effective SV in the process.…”

Decreased biventricular longitudinal strain in patients with systemic sclerosis is mainly caused by pulmonary hypertension and not by systemic sclerosis per se

“…However, in that study, mostly patients without SSc were included and SSc-PAH might not be phenotypically representative for the whole group of PAH (Chung et al, 2010;Hsu et al, 2011). The decline in LV function due to PAH is in concordance with a study by Hardegree et al (2013) using echocardiography and with an earlier study using CMR showing altered regional contribution to ventricular stroke volume in pulmonary hypertension (Ostenfeld et al, 2016).…”

“…The decline in LV function due to PAH is in concordance with a study by Hardegree et al . () using echocardiography and with an earlier study using CMR showing altered regional contribution to ventricular stroke volume in pulmonary hypertension (Ostenfeld et al ., ).…”

Imaging the right heart pulmonary circulation unit: Insights from advanced ultrasound techniques

“…divided the RV into three compartments (inflow and outflow tract, and apex) from 3DE images and calculated the timing of contraction of each compartment as well as the compartmental ejection fractions, and they found differences between patients with pulmonary hypertension, patients with ischemic heart failure without pulmonary hypertension and normal controls. The regional contribution to stroke volume has recently been quantified in patients with PH and compared to normal controls . Interestingly, the longitudinal contribution was altered on the left side despite preserved LVEF.…”