Pulmonary hypertension is associated with abnormal right ventricular early relaxation and increased filling pressures, suggesting diastolic dysfunction precedes systolic dysfunction.
Observational (n=25)
Is pulmonary hypertension associated with abnormal right ventricular early relaxation as measured by invasive pressure measurement?
Invasive hemodynamic measurements demonstrate that right ventricular early relaxation is abnormal in patients with pulmonary hypertension, suggesting that RV diastolic dysfunction may precede systolic dysfunction.
Left ventricular diastolic dysfunction is a well-described complication of systemic hypertension. However, less is known regarding the effect of chronic pressure overload on right ventricular (RV) diastolic function. We hypothesized that pulmonary hypertension (PHT) is associated with abnormal RV early relaxation and that this would be best shown by invasive pressure measurement. Twenty-five patients undergoing right heart catheterization for investigation of breathlessness and/or suspected PHT were studied. In addition to standard measurements, RV pressure was sampled with a high-fidelity micromanometer, and RV pressure/time curves were analyzed. Patients were divided into a PHT group and a non-PHT group on the basis of a derived mean pulmonary artery systolic pressure of 25 mmHg. Eleven patients were classified to the PHT group. This group had significantly higher RV minimum diastolic pressure (Formula: see text vs. Formula: see text mmHg, Formula: see text) and RV end-diastolic pressure (RVEDP; Formula: see text vs. Formula: see text mmHg, Formula: see text), and RV τ was significantly prolonged (Formula: see text vs. Formula: see text ms, Formula: see text). There were strong correlations between RV τ and RV minimum diastolic pressure (Formula: see text, Formula: see text) and between RV τ and RVEDP (Formula: see text, Formula: see text). There was a trend toward increased RV contractility (end-systolic elastance) in the PHT group (Formula: see text vs. Formula: see text mmHg/mL, Formula: see text) and a correlation between RV systolic pressure and first derivative of maximum pressure change (Formula: see text, Formula: see text). Stroke volumes were similar. Invasive measures of RV early relaxation are abnormal in patients with PHT, whereas measured contractility is static or increasing, which suggests that diastolic dysfunction may precede systolic dysfunction. Furthermore, there is a strong association between measures of RV relaxation and RV filling pressures.
Murch et al. (Thu,) conducted a observational in Pulmonary hypertension (n=25). Pulmonary hypertension vs. Non-pulmonary hypertension was evaluated on Right ventricular early relaxation (RV τ) and filling pressures. Pulmonary hypertension is associated with abnormal right ventricular early relaxation and increased filling pressures, suggesting diastolic dysfunction precedes systolic dysfunction.