Abstract 11769: Association between Left Ventricular Geometry and Right Ventricular Contractile Function in Patients with Normal Ejection Fraction
Background: The interventricular septum is shared by left and right ventricles (LV and RV), and its contraction contributes to RV contractile function. RV contractility is also influenced by the afterload, which is greatly affected by LV end-diastolic pressure (LVEDP). LV hypertrophy and its geometry affect LV systolic and diastolic function, but its effects on RV function are not well elucidated. We investigated the relation between LV geometry and RV function in patients with normal LV ejection fraction (LVEF).
Methods and Results: We recorded echocardiogram in consecutive 915 patients with (1) no structural heart disease (2) LVEF ≥60% (3) no significant mitral or tricuspid regurgitation, and (4) serum creatinine <2.0 mg/dL. We calculated left ventricular mass index (LVMI, g/m2) and relative wall thickness (RWT), and divided the study patients into the concentric hypertrophy (LVMI >115 (male) /95(female) and RWT>0.42), concentric remodeling (normal LVMI and RWT ≤0.42), eccentric hypertrophy (increased LVMI and RWT ≤0.42), and the normal group. Tricuspid annular plane systolic excursion (TAPSE) was measured as an index of RV contractile function. TAPSE <17mm was defined as impaired RV function. Diameter of inferior vena cava (IVC) and E/e’ were measured as indices of and right atrial pressure and LVEDP. Patients with concentric hypertrophy (n=346) had significantly lower TAPSE (19.6±4.4mm) than those with normal geometry (20.9±3.8mm, n=230) and with eccentric remodeling (20.5±4.4mm, n=191), even after correction of IVC, E/e’ and serum creatinine. TAPSE in the concentric remodeling group (20.1±4.4mm, n=148) was not different from those in other three groups. The concentric hypertrophy group had significantly higher incidence of impaired RV function (25.7%, p<0.001) than other groups. Multivariate regression analysis selected the presence of concentric hypertrophy as an independent predictor for impaired RV function (odds ratio 3.2 [95% confidence interval 1.7 - 6.1], vs. the normal group), along with left atrial and LV dimensions, among echocardiography parameters.
Conclusion: Concentric hypertrophy was associated with lower TAPSE, suggesting that LV geometry could affect RV function in patients with normal LVEF.
- © 2012 by American Heart Association, Inc.