title: Interdependence of right ventricular systolic function and left ventricular filling and its association with outcome for patients with pulmonary hypertension.
abstract: Although impaired right ventricular (RV) performance has been associated with adverse outcomes for pulmonary hypertension (PH) patients, the relationship between bi-ventricular interdependence and outcomes is not yet fully understood. We studied 96 PH patients. RV systolic function was assessed by means of RV free-wall longitudinal speckle-tracking strain (RV-free), and left ventricular (LV) filling as early diastolic transmitral flow velocity (TMF-E). RV-free ≤19 % and TMF-E <60 cm/s were adopted as pre-defined cut-offs for RV systolic dysfunction and LV under-filling, respectively, associated with worse outcomes. Long-term outcome was tracked over 2.2 years. RV-free correlated significantly with TMF-E (r = 0.57, p < 0.001).TMF-E and RV-free were significantly lower in patients with than in those without cardiac events. RV systolic dysfunction and LV under-filling was observed in 35 patients. These features were associated with worse long-term survival compared to other sub-groups (log-rank p = 0.012). A sequential Cox model based on clinical variables including world health organization functional class IV and brain natriuretic peptide >150 pg/dl (χ(2) = 1.2) was improved by the addition of RV-free (χ(2) = 5.5, p = 0.04) as well as of TMF-E (χ(2) = 11.5, p = 0.01). In conclusions, RV systolic function was shown to correlate significantly with LV filling in PH patients. In addition, not only assessment of RV systolic function, but also of a combined bi-ventricular parameter comprising RV systolic function and LV filling may well have clinical implications for more successful management of PH patients.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Motoji
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yuko
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sano
authors.forename: Keiko
authors.initials: K
authors.lastname: Ryo
authors.forename: Junichi
authors.initials: J
authors.lastname: Imanishi
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Takuma
authors.initials: T
authors.lastname: Sawa
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Mochizuki
authors.forename: Kensuke
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Noriaki
authors.initials: N
authors.lastname: Emoto
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right