title: Impaired right and left ventricular mechanics in adults with pulmonary hypertension and congenital shunts.
abstract: OBJECTIVE
  To assess left ventricle mechanics in Eisenmenger physiology patients with congenital shunts, and their relationship with the right ventricle, and to consider the clinical usefulness of this information.
  
  
  METHODS
  The study involved 28 patients with pulmonary artery hypertension (PAH) and congenital shunt, matched with 28 healthy participants. Standard echocardiography and pulsed wave tissue Doppler imaging were employed to analyze systolic and diastolic ventricular function, the myocardial performance index (MPI) of ventricles, and the strain and strain rate along the left ventricle lateral wall, septum, and right ventricle free wall.
  
  
  RESULTS
  The left ventricle ejection fraction was similar in the two groups. However, despite normal standard left ventricle measures, patients presented parameters of defective myocardial mechanics: mitral peak systolic velocity (S') (cm/s) (8.6 (7.6-10.9) vs. 10.7 (8.6-12.5); P = 0.002) was higher, whereas left ventricle-MPI was lower (0.54 ± 01 vs. 0.32 ± 0.07, P < 0.001). Right ventricle-MPI and right ventricle global strain were correlated significantly with left ventricle-MPI and left ventricle global strain (r = 0.74, P < 0.001; r = 0.442, P < 0.001, respectively). Clinically, the six-minute walking test results were correlated negatively with left ventricle-MPI (r = -0.69, P < 0.001), whereas the functional class was positively correlated (r = 0.36, P < 0.001). In conclusion, left ventricle mechanics and geometry are impaired in Eisenmenger syndrome patients, although conventional evaluation is in the normal range. Our results highlight the significance of ventricular interdependence in PAH and provide a useful tool for improving the clinical management of these patients.
authors: aDepartment of Medicine, Cadiz University School of Medicine, CadizbAdult Congenital Heart Disease Unit, Clinical Management Area of the Heart, University Hospital 'Virgen del Rocio', SevillecCardiology Department, Hospital Carlos III, Madrid, Spain.
authors: Rocio
authors: R
authors: Toro
authors: Maria Luisa
authors: ML
authors: Cabeza-Letrán
authors: Maribel
authors: M
authors: Quezada
authors: Maria Jose
authors: MJ
authors: Rodriguez-Puras
authors: Alipio
authors: A
authors: Mangas
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004452:Echocardiography / Q000379:methods; D004541:Eisenmenger Complex / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D008875:Middle Aged; D011446:Prospective Studies; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D055815:Young Adult