title: Left ventricular diastolic dysfunction and increased left ventricular mass index related to pulmonary hypertension in patients with systemic autoimmune disease without pericardial effusion.
abstract: OBJECTIVE
  We investigated the relationship of left ventricular (LV) diastolic dysfunction and LV mass index (LVMI) against pulmonary hypertension (PH) in systemic autoimmune disease (SAD).
  
  
  METHODS
  A total of 84 SAD patients (68 females; 53±17years; systemic lupus erythematosus, 27%; scleroderma, 17%; vasculitis, 16%; mixed connective tissue disease, 13% and polymyositis/dermatomyositis complex, 10%) without significant pericardial effusion (PE) on TTE (Vivid E9, GE) were analyzed. On TTE, PH was defined as peak tricuspid regurgitation velocity (TRV) of ≥2.9m/s based upon 2015 ESC guideline. Left atrial volume index (LAVI) and E/E' were measured as indicators of LV diastolic dysfunction. LVMI was also measured.
  
  
  RESULTS
  Seven patients (8%) had PH. PH patients had greater LAVI (p<0.001), E/E' (p=0.004), LVMI (p=0.009) than non-PH patients. LAVI (R=0.458), E/E' (R=0.337), and LVMI (R=0.313) significantly and positively correlated with TRV (all p<0.05). Multiple regression analysis was performed to explore determinants of TRV. Age, female sex, and brain natriuretic peptide (BNP) were included in all the models. Three multiple regression models were generated using 1) LAVI, 2) E/E', and 3) LVMI and included LAVI, E/E', LVMI, and BNP as significant variables influencing TRV. Multi logistic regression analysis for predicting TRV of ≥2.9m/s showed that LAVI, and E/E' were significant predictors (Odds ratio, 1.296, and 1.370, respectively).
  
  
  CONCLUSIONS
  In SAD patients without PE, LV diastolic dysfunction and increment of LVMI was closely associated with PH based upon TRV. LAVI and E/E' were independent predictors for PH. Measuring LAVI and E/E' may be a key to determine the mechanism of PH in these patients.
authors.affiliation: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sugiura
authors.affiliation: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. Electronic address: nobusada@w8.dion.ne.jp.
authors.forename: Nobusada
authors.initials: N
authors.lastname: Funabashi
authors.affiliation: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
authors.forename: Koya
authors.initials: K
authors.lastname: Ozawa
authors.affiliation: Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kobayashi
mesh_terms: D000367:Age Factors; D001327:Autoimmune Diseases / Q000145:classification / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis; D009929:Organ Size; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013223:Statistics as Topic; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Left Ventricular Diastolic Dysfunction; Left Ventricular Mass Index; Pericardial Effusion; Pulmonary Hypertension; Systemic Autoimmune Disease