Elevated pulmonary artery systolic pressure in patients with coronary artery disease and left ventricular dyssynchrony.
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.
Yan
Guo-Hui
GH
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.
Wang
Mei
M
Yue
Wen-Sheng
WS
Yiu
Kai-Hang
KH
Siu
Chung-Wah
CW
Lee
Stephen W L
SW
Lau
Chu-Pak
CP
Tse
Hung-Fat
HF
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