title: Elevated pulmonary artery systolic pressure in patients with coronary artery disease and left ventricular dyssynchrony.
abstract: OBJECTIVE
  We sought to determine whether inter- or intra-ventricular systolic dyssynchrony contributes to the occurrence of elevated pulmonary artery systolic pressure (PASP) in patients with coronary artery disease (CAD).
  
  
  RESULTS
  One hundred and fifty-three consecutive CAD patients with preserved left ventricular ejection fraction (LVEF >40%) were enrolled. Detailed echocardiography was performed to measure PASP, inter-ventricular dyssynchrony (Ts-RL: time difference between lateral and right free wall), and intra-ventricular dyssynchrony (Ts-SD, standard deviation of time to peak systolic velocity of 12 LV segments; Ts-12, maximal difference in Ts between any 2 of 12 LV segments; Ts-6-basal, maximal difference in Ts between any 2 of 6 basal LV segments). Elevated PASP (>35 mmHg) was confirmed in 46 patients who had significantly prolonged intra-ventricular dyssynchrony (Ts-SD: 49.9 ± 19.6 vs.37.9 ± 19.8 ms; Ts-12: 147.9 ± 56.4 vs.110.9 ± 53.9 ms; Ts-6-basal: 114.2 ± 51.9 vs. 85.7 ± 48.5 ms, all P < 0.01) and inter-ventricular dyssynchrony (Ts-RL: 78.7 ± 46.4 vs. 62.7 ± 34.3 ms, P = 0.019) compared with those without elevated PASP. Indexes of intra- and inter-ventricular dyssynchrony and LV filling pressure (E/e') were significantly correlated with PASP. Multivariate analysis showed that left atrial dimension [odds ratio (OR) 4.23, 95% confidence interval (CI) 1.64-10.90], E/e' septal (OR 1.15, 95% CI 1.04-1.27), pulmonary vascular resistance (OR 5.38, 95% CI 1.55-18.74), and Ts-RL (OR 1.02, 95% CI 1.01-1.03) were independent predictors for the occurrence of elevated PASP (all P < 0.05).
  
  
  CONCLUSIONS
  Elevated PASP is common in CAD patients with preserved LVEF and is associated with LV diastolic dysfunction and LV mechanical dyssynchrony.
authors.affiliation: Cardiology Division, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Rm 1928, Block K, Queen Mary Hospital, Hong Kong, Hong Kong.
authors.forename: Guo-Hui
authors.initials: GH
authors.lastname: Yan
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.forename: Wen-Sheng
authors.initials: WS
authors.lastname: Yue
authors.forename: Kai-Hang
authors.initials: KH
authors.lastname: Yiu
authors.forename: Chung-Wah
authors.initials: CW
authors.lastname: Siu
authors.forename: Stephen W L
authors.initials: SW
authors.lastname: Lee
authors.forename: Chu-Pak
authors.initials: CP
authors.lastname: Lau
authors.forename: Hung-Fat
authors.initials: HF
authors.lastname: Tse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003971:Diastole; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D012307:Risk Factors; D013223:Statistics as Topic; D013318:Stroke Volume; D013599:Systole; D018608:Ultrasonography, Doppler; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D016277:Ventricular Function, Left