Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
Division of Cardiology, Hakodate Municipal Hospital, 1-10-1, Minato-cho, Hakodate 041-8680, Japan.
Eur Heart J Cardiovasc Imaging. 2022 Sep 10;23(10):1399-1406. doi: 10.1093/ehjci/jeab285.
Although the left ventricular (LV) dysfunction in pre-capillary pulmonary hypertension (PH) has been recently recognized, the mechanism of LV dysfunction in this entity is not completely understood. We thus aimed to elucidate the determinants of intraventricular pressure difference (IVPD), a measure of LV suction, in pre-capillary PH.
Right heart catheterization and echocardiography were performed in 86 consecutive patients with pre-capillary PH (57 ± 18 years, 85% female). IVPD was determined using colour M-mode Doppler to integrate the Euler equation. In overall, IVPD was reduced compared to previously reported value in normal subjects. In univariable analyses, QRS duration (P = 0.028), LV ejection fraction (P = 0.006), right ventricular (RV) end-diastolic area (P < 0.001), tricuspid annular plane systolic excursion (P = 0.004), and LV early-diastolic eccentricity index (P = 0.009) were associated with IVPD. In the multivariable analyses, RV end-diastolic area and LV eccentricity index independently determined the IVPD.
Aberrant ventricular interdependence caused by RV enlargement could impair the LV suction. This study first applied echocardiographic IVPD, a reliable marker of LV diastolic suction, to investigate the mechanism of LV diastolic dysfunction in pre-capillary PH.
虽然毛细血管前肺动脉高压（PH）患者的左心室（LV）功能障碍最近已得到承认，但该实体中 LV 功能障碍的机制尚不完全清楚。因此，我们旨在阐明毛细血管前 PH 患者 LV 抽吸的室内压力差（IVPD）的决定因素。
对 86 例连续的毛细血管前 PH 患者（57±18 岁，85%为女性）进行了右心导管检查和超声心动图检查。使用彩色 M 型多普勒积分 Euler 方程来确定 IVPD。总体而言，IVPD 较正常人群的先前报道值降低。在单变量分析中，QRS 持续时间（P=0.028）、LV 射血分数（P=0.006）、右心室（RV）舒张末期面积（P<0.001）、三尖瓣环平面收缩期位移（P=0.004）和 LV 舒张早期偏心指数（P=0.009）与 IVPD 相关。在多变量分析中，RV 舒张末期面积和 LV 偏心指数独立决定 IVPD。
RV 增大导致的异常心室相互依存可能会损害 LV 抽吸。本研究首次应用超声心动图 IVPD，一种可靠的 LV 舒张抽吸标志物，来研究毛细血管前 PH 中 LV 舒张功能障碍的机制。
