Altered Early Left Ventricular Diastolic Wall Velocities in Pulmonary Hypertension: A Tissue Doppler Study

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.