Abstract 2353: Prediction of Clinical and Hemodynamic Status by the Pattern of Interventricular Septal Motion in Patients with Pulmonary Hypertension
Purpose: We notice that patients with pulmonary hypertension (PH) show either of the following motions of the interventricular septum (IVS) by M-mode echocardiography: type A, marked anterior motion in early systole; type B, marked posterior motion in early diastole.
Methods: To investigate the clinical and hemodynamic implications of these 2 types, we performed echocardiography on 32 patients with PH (42±13 years) within 1 week of cardiac catheterization.
Results: There were 14 with type A and 18 with type B. No differences were found in pressure gradient of tricuspid regurgitation (73±25 vs. 81±25 mmHg), left ventricular eccentricity index (2.4±0.6 vs. 2.1±0.7) and mean pulmonary arterial pressure by catheterization (54±10 vs. 53±13 mmHg) between the 2 types. However, NYHA class (2.7±0.4 vs. 2.2±0.3) and BNP (271±155 vs. 74±55 pg/ml) were significantly higher and cardiac index (CI, 1.7±0.3 vs. 2.3±0.4 l/min/m2) was significantly lower in type A patients (p<0.01). From simultaneous recordings of both ventricular pressures, we found that right ventricular pressure was higher than left ventricular pressure during whole diastole in type A patients, but only during early diastole in type B patients consistent with the M-mode IVS motion. In multivariate analysis, type A significantly predicted CI<1.8 l/min/m2 (Odds Ratio 32.7, p=0.027).
Conclusions: The IVS motion in PH reflecting the transseptal pressure gradient could predict disease status. Patients with marked anterior motion in early systole were more morbid clinically and hemodynamically than patients with marked posterior motion in early diastole.