Diminished Aortic Excursion in Chronic Thromboembolic Pulmonary Hypertension

BACKGROUND: Although studies have found diminished aortic root motion in left ventricular systolic dysfunction, few data exist on aortic root excursion in isolated right ventricular dysfunction due to chronic thromboembolic pulmonary hypertension (CTEPH). OBJECTIVE: We conducted this study to evaluate aortic root excursion in CTEPH. METHODS: We studied 20 consecutive patients with CTEPH, normal left ventricular ejection fraction and pulmonary capillary wedge pressures, and 10 normal control subjects. Anterior excursion of the aortic root was measured using M-mode echocardiography as the difference between the maximal and minimal anterior distance of the posterior wall of the aortic root at the level of the aortic valve. RESULTS: Mean aortic excursion for CTEPH patients was approximately half that of normal controls (0.66 ± 0.25 cm vs. 1.16 ± 0.15 cm, P < 0.0001). There was a significant inverse linear correlation between mean pulmonary artery pressure and aortic excursion in the CTEPH group (r = 0.66, P = 0.001). CONCLUSION: Aortic excursion is diminished in the right ventricular pressure overload of CTEPH. This impaired motion of the aortic root may influence systolic expansion of the left atrium, and may contribute to the impaired left atrial diastolic filling patterns often seen in patients with CTEPH.