Key result
Pulmonary arterial hypertension was associated with significantly lower left ventricular atrioventricular plane displacement (11.6 vs 16.1 mm) and global longitudinal strain compared to controls, driven by underfilling rather than intrinsic dysfunction.
Why the study?
To evaluate the association between impaired left ventricular longitudinal function and left ventricular underfilling in patients with pulmonary arterial hypertension.
Cross-Sectional (n=57)
No
Absolute Event Rate: 11.6% vs 16.1%
p-value: p=< 0.0001
LV underfilling should be considered when interpreting LV function in PAH; leaves open validation for prognosis or management.
To evaluate the association between impaired left ventricular (LV) longitudinal function and LV underfilling in patients with pulmonary arterial hypertension (PAH). Thirty-nine patients with PAH and 18 age and sex-matched healthy controls were included. LV volume and left atrial volume (LAV) were delineated in short-axis cardiac magnetic resonance (CMR) cine images. LV longitudinal function was assessed from atrio-ventricular plane displacement (AVPD) and global longitudinal strain (GLS) was assessed using feature tracking in three long-axis views. LV filling was assessed by LAV and by pulmonary artery wedge pressure (PAWP) using right heart catheterisation. Patients had a smaller LAV, LV volume and stroke volume as well as a lower LV-AVPD and LV-GLS than controls. PAWP was 6 [IQR 5--9] mmHg in patients. LV ejection fraction did not differ between groups. LV stroke volume correlated with LV-AVPD (r = 0.445, p = .001), LV-GLS (r = - 0.549, p < 0.0001) and LAVmax (r = .585, p < 0.0001). Furthermore, LV-AVPD (r = .598) and LV-GLS (r = - 0.675) correlated with LAVmax (p < 0.0001 for both). Neither LV-AVPD, LV-GLS, LAVmax nor stroke volume correlated with PAWP. Impaired LV longitudinal function was associated with low stroke volume, low PAWP and a small LAV in PAH. Small stroke volumes and LAV, together with normal LA pressure, implies that the mechanism causing reduced LV longitudinal function is underfilling rather than an intrinsic LV dysfunction in PAH.
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Sjögren et al. (2021) conducted a cross-sectional in Pulmonary arterial hypertension (n=57). Pulmonary arterial hypertension vs. Healthy controls was evaluated on Left ventricular atrioventricular plane displacement (LV-AVPD) in mm (p=< 0.0001). Pulmonary arterial hypertension was associated with significantly lower left ventricular atrioventricular plane displacement (11.6 vs 16.1 mm) and global longitudinal strain compared to controls, driven by underfilling rather than intrinsic dysfunction.
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