title: Different patterns of adaptation of the right ventricle to pressure overload: a comparison between pulmonary hypertension and pulmonary stenosis.
abstract: BACKGROUND
  The study was designed to compare RV morphological and functional parameters derived from conventional and myocardial deformation echocardiography in two instances of right heart pressure overload: pulmonary arterial hypertension (PAH) and pulmonary stenosis (PS).
  
  
  METHODS
  Sixty-two individuals were included: 22 patients with pulmonary arterial hypertension (PAH), 19 patients with PS and 21 healthy individuals who served as a control group. All patients had clinical evaluation with 6-minute walking test, standard and two-dimensional strain echocardiography and B-type natriuretic peptide evaluation.
  
  
  RESULTS
  At similar levels of pressure overload (RV systolic pressure, 88.2 ± 31.5 vs 73.4 ± 34.9 mm Hg; P = NS) the right ventricles of patients with PS were less dilated (RV end-diastolic diameter, 31.7 ± 3.7 vs 43.7 ± 10.5 mm; P < .001) and performed significantly better than those of patients with PAH (RV strain, -27.4 ± 5.8% vs 16.2 ± 7.9%; RV fractional area change, 51.1 ± 9.2% vs 29.1 ± 11.3%; P < .001). Although some of the RV functional parameters were comparable with those in healthy individuals, strain rate showed lower values, suggesting subclinical longitudinal dysfunction in patients with PS. Myocardial stress biomarkers were correlated with RV systolic pressure only in patients with PAH (r = 0.64, P = .03), not in those with PS (r = 0.22, P = .50).
  
  
  CONCLUSIONS
  At similar levels of pressure overload, the right ventricle is less dilated and performs better in patients with PS compared with those with PAH.
authors.affiliation: Department of Cardiology, "Prof. Dr. C. C. Iliescu" Institute of Emergency for Cardiovascular Diseases, Bucharest, Romania. rjurcut@gmail.com
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Jurcut
authors.forename: Sorin
authors.initials: S
authors.lastname: Giusca
authors.forename: Razvan
authors.initials: R
authors.lastname: Ticulescu
authors.forename: Elena
authors.initials: E
authors.lastname: Popa
authors.forename: Mihaela-Silvia
authors.initials: MS
authors.lastname: Amzulescu
authors.forename: Ioana
authors.initials: I
authors.lastname: Ghiorghiu
authors.forename: Ioan Mircea
authors.initials: IM
authors.lastname: Coman
authors.forename: Bogdan Alexandru
authors.initials: BA
authors.lastname: Popescu
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Voigt
authors.forename: Carmen
authors.initials: C
authors.lastname: Ginghina
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D003937:Diagnosis, Differential; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D009200:Myocardial Contraction; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016278:Ventricular Function, Right / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*