Left ventricular function in pulmonary hypertension
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ORIGINAL ARTICLE
Left ventricular function in pulmonary hypertension Hirohisa Amano • Shigeru Toyoda • Takuo Arikawa • Shu Inami • Naoyuki Otani • Yu Nishi • Yoshiyuki Kitagawa Isao Taguchi • Shichiro Abe • Teruo Inoue
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Received: 17 February 2012 / Accepted: 13 July 2012 / Published online: 4 November 2012 Ó Springer 2012
Abstract To elucidate left ventricular function in pulmonary hypertension, we measured parameters of left ventricular as well as right ventricular function by echocardiography in 11 patients with pulmonary hypertension (idiopathic pulmonary artery hypertension in 4, chronic thromboembolic pulmonary hypertension in 5, and other pulmonary hypertension in 2). The percent change in these parameters 6 months after treatment with pulmonary artery vasodilators (beraprost in 8 and sildenafil in 3) was assessed. There was a correlation between the relative change in right ventricular systolic pressure (RVSP) and the relative changes in left ventricular outflow tract velocity–time integral (r = -0.730, P = 0.011) and mitral valve velocity–time integral (r = -0.621, P = 0.041). However, there was no correlation between the relative change in RVSP and the relative changes in left ventricular ejection fraction, left ventricular diastolic dimension, and systolic blood pressure. The relative change in RVSP was also correlated with the relative change in early diastolic myocardial velocity at the medial mitral annulus (r = -0.675, P = 0.023). Reduction of RVSP by pulmonary artery vasodilators might increase left ventricular preload, leading to an increase in stroke volume. Right ventricular load reduction might improve left ventricular diastolic
H. Amano S. Toyoda (&) T. Arikawa S. Inami N. Otani Y. Nishi Y. Kitagawa I. Taguchi S. Abe T. Inoue Department of Cardiovascular Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Tochigi, Japan e-mail: [email protected]
function in patients with pulmonary hypertension, possibly through altered interventricular septal performance. Keywords Pulmonary hypertension Right ventricular systolic pressure Left ventricular function Left ventricular diastolic function Pulmonary artery vasodilator
Introduction Pulmonary hypertension of any etiology is a rapidly progressive disease and is associated with a high mortality despite medical interventions [1]. Since pulmonary artery hypertension leads to right heart failure via right cardiac pressure overload, right ventricular function including pulmonary artery pressure, right ventricular or atrial pressures, right ventricular or atrial enlargement, and tricuspid regurgitation are often evaluated in the clinical setting [2]. By contrast, left ventricular function in pulmonary artery hypertension is not well understood. Several studies using Doppler echocardiographic measurement have suggested impaired left ventricular filling in pulmonary hypertension [3, 4]. In these studies, left ventricular isovolumic relaxation time was prolonged in patients with pulmonary hypertension in co
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