Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
Department of Cardiology Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Cardiovasc Hematol Disord Drug Targets. 2021;21(1):78-86. doi: 10.2174/1871529X21666210401150404.
Ventricular interdependence in pulmonary arterial hypertension (PAH) by the use of most recent echocardiographic techniques is still rare. The current case-controlled study aims to assess left ventricular (LV) torsion in patients with PAH.
The study included 42 cases of moderate to severe PAH and 42 age and gender-matched healthy controls between March 2016 and January 2018. All the patients and controls undergo routine practice echocardiography using the Vivid 7-echocardiography (2.5MHz transducer) system.
The LV twisting parameters, peak basal rotation, peak apical rotation, and twist were similar among both cases and controls, however, LV torsion was significantly (p=0.04) impacted. Right ventricular (RV) longitudinal deformation was clinically significant in the cases compared to controls: RV systolic strain imaging (p=0.001, 95% CI-9.75 to -2.65), RV systolic strain rate (p=0.01, 95% CI-0.99 to -0.09), and RV late diastolic strain rate (p=0.01, 95% CI-0.64 to -0.85). Although PAH did not impact longitudinal LV deformations significantly. At basal level circumferential strain and strain rate were significantly impacted (p=0.005, 95% CI-4.38 to -0.70; p=0.004, 95% CI-0.35 to -0.07) in the PAH group, while the radial strain was preserved. All RV echocardiographic parameters and LV end-diastolic dimension, LV end-systolic volume in the PAH were affected significantly (p=0.002, 95% CI-19.91 to -4.46; p=0.01, 95% CI-8.44 to -2.77). However, only a weak correlation (p=0.05, r =-0.20) was found between tricuspid annular plane systolic excursion and LV Tei index.
RV pressure overload directly affects RV longitudinal systolic deformation further influences the interventricular septal and LV geometry, which impaired LV torsion.
应用最新的超声心动图技术评估肺动脉高压（PAH）患者的心室相互依赖性仍然很少见。本病例对照研究旨在评估 PAH 患者的左心室（LV）扭转。
该研究纳入了 2016 年 3 月至 2018 年 1 月期间 42 例中重度 PAH 患者和 42 例年龄和性别匹配的健康对照者。所有患者和对照者均采用 Vivid 7 超声心动图（2.5MHz 探头）系统进行常规实践超声心动图检查。
两组 LV 扭转参数（基底段峰值旋转、心尖段峰值旋转和扭转）相似，但 LV 扭转明显受影响（p=0.04）。与对照组相比，右心室（RV）纵向变形在病例组中具有临床意义：RV 收缩期应变成像（p=0.001，95%置信区间-9.75 至-2.65）、RV 收缩期应变率（p=0.01，95%置信区间-0.99 至-0.09）和 RV 舒张晚期应变率（p=0.01，95%置信区间-0.64 至-0.85）。尽管 PAH 对 LV 纵向变形无明显影响，但在基底段时周向应变和应变率明显受影响（p=0.005，95%置信区间-4.38 至-0.70；p=0.004，95%置信区间-0.35 至-0.07），而 RV 径向应变则得以保持。PAH 组的所有 RV 超声心动图参数和 LV 舒张末期内径、LV 收缩末期容积均受到显著影响（p=0.002，95%置信区间-19.91 至-4.46；p=0.01，95%置信区间-8.44 至-2.77）。然而，仅发现三尖瓣环平面收缩期位移与 LVTei 指数之间存在弱相关性（p=0.05，r=-0.20）。
RV 压力超负荷直接影响 RV 纵向收缩性变形，进一步影响室间隔和 LV 几何形状，从而损害 LV 扭转。
