Left-sided heart failure with pulmonary hypertension was associated with reduced right ventricular ejection fraction across inflow (p<0.001), apical (p<0.01), and outflow (p<0.05) compartments.
Observational (n=45)
How does secondary pulmonary arterial hypertension affect right ventricular regional function assessed by 3D echocardiography in patients with left-sided heart failure?
3D echocardiography reveals that secondary pulmonary hypertension in left-sided heart failure causes the right ventricle to lose its normal sequential contraction and become a single dyssynchronous compartment.
BACKGROUND: The right ventricle is multicompartmental in orientation. OBJECTIVE: To assess the normal differential function of the right ventricular (RV) inflow, apical and outflow compartments, also their inter-relations and the response to pulmonary arterial hypertension (PAH). METHODS: 45 people were studied--16 controls and 29 patients with left-sided heart failure, 15 without (group 1) and 14 with (group 2) secondary PAH, using two-dimensional (2D) and 3D echocardiography in addition to conventional Doppler techniques. RESULTS: There was a strong correlation between RV inlet diameter (2D) and end-diastolic volume (3D) (r=0.69, p<0.001) and between tricuspid annular plane systolic excursion and RV ejection fraction (3D) (r=0.71, p<0.001). In controls and patients, the apical ejection fraction was less than the inflow and outflow (controls: p<0.01 and p<0.01, group 1: p<0.05 and p<0.01 and group 2: p<0.05 and p<0.01, respectively). Ejection fraction was reduced in patients (inflow: p<0.001 for both, apical: p<0.01 for both and outflow tract: p<0.05 for both). In controls, the inflow compartment reached the minimum volume 20 ms before the outflow and apex but in group 2 it was simultaneous. Isovolumic contraction and relaxation times were prolonged in patients (Group 1: p=0.02 and p<0.01 and Group 2: p=0.01 for both). Peak RV ejection time correlated with the rate of outflow volume fall in controls but with the apex in group 2 (r=0.6, p<0.05). CONCLUSION: The right ventricle has distinct features for the inflow, apical and outflow tract compartments, with different extent of contribution to the overall systolic function. In PAH, the right ventricle becomes one dyssynchronous compartment, which itself may have perpetual effect on overall cardiac dysfunction.
Calcutteea et al. (Tue,) conducted a observational in Left-sided heart failure and secondary pulmonary arterial hypertension (n=45). Left-sided heart failure and secondary pulmonary arterial hypertension vs. Healthy controls was evaluated on Differential function of the right ventricular inflow, apical and outflow compartments. Left-sided heart failure with pulmonary hypertension was associated with reduced right ventricular ejection fraction across inflow (p<0.001), apical (p<0.01), and outflow (p<0.05) compartments.