Abstract 4385: Prevalence and Prognostic Significance of Diastolic Dysfunction in Pulmonary Hypertension
Background: Diastolic filling abnormalities have been described in patients with severe pulmonary hypertension (PH), but their clinical significance is unclear. Noninvasive estimation of left atrial pressure (LAP) measured by the ratio of early mitral filling velocity (E) to early diastolic mitral annular velocity (E′) is known to predict prognosis in patients with left ventricular (LV) systolic dysfunction. E/E′ ratio > 15 carries an adverse prognosis in these patients. The current study describes the prevalence and prognostic significance of the various stages of diastolic dysfunction in patients with PH and normal LV systolic function.
Methods: 2D Echocardiograms of 67 pts, ages 24 – 80 yrs with PH and LVEF>50% were analyzed for the presence of diastolic dysfunction. Diastolic filling abnormalities were classified as impaired relaxation, pseudonormal or restrictive based on E/A, and E/E′ ratios. The E/E′ ratio between the group with severe PH and the group with mild-moderate PH was compared. Outcome assessment included the need for hospitalization for decompensated heart failure.
Results: 36 patients had severe PH (PAP >=65mmHg), whereas 31 had mild-moderate PH (PAP<65mm Hg). Impaired relaxation was the most common diastolic pattern present in 25 patients (37%), whereas pseudonormal was present in 6 patients (9%), and restrictive pattern in 7 patients (10%). There was a trend toward lower E/E′ in the severe PH group (8.83+−3.72 vs 11.32+−6.31; p=0.06). When patients were categorized by E/E′>/<15, there were no differences in the frequency of hospitalization (8.3% vs. 14.3%, p=0.1).
Impaired relaxation evidenced by lower early mitral filling velocity is the most prevalent diastolic abnormality in patients with PH.
An inverse relationship exists between PA pressures and E/E′ ratio, suggesting that LAP decreases with increase in PA pressure possibly due to lower LA filling and preload.
E/E′ ratio>15 did not predict adverse clinical outcome.
These findings suggest that E/E′ may not carry the same prognostic value in patients with PH and normal LV systolic function as those with LV systolic dysfunction.