Abstract 17226: Left Ventricular Mechanics in Patients With Pulmonary Arterial Hypertension: Relationship With Outcomes
Background: Patients with severe pulmonary arterial hypertension (PAH) frequently present with a severely dilated and dysfunctional right ventricle (RV) together with a small left ventricle (LV) with apparently preserved performance. We hypothesized that these changes in RV geometry and function would adversely impact left ventricular mechanics and have a negative influence on outcomes.
Methods: We studied 50 patients (55±14 years, 18% male) with severe PAH (pulmonary arterial pressure 82±19mmHg and D-shaped septum) and 40 age- and gender-matched controls (CTRL) with normal LV ejection fraction (LVEF>55%) based on biplane Simpson analysis (Table). LV apical 4-, 2-, and 3-chamber and mid short-axis views were analyzed using 2D speckle-tracking to obtain LV global longitudinal, circumferential and radial strain (LS, CS, RS) (Epsilon). Measurements were compared between PAH patients and CTRL. PAH patients were divided into survivors and non-survivors (follow-up 2.4±1.6 years) and Kaplan-Meier curves were constructed.
Results: Eighty percent of PAH etiology was idiopathic or connective tissue disease. There was no difference in LVEF between PAH and CTRL. However, LV global LS, CS and RS were reduced in PAH patients compared to CTRL (Table). There were 19 deaths in the PAH group (38%). Despite the lack of differences in LVEF between PAH survivors and non-survivors, LV global LS was significantly different between these sub-groups, while LV global CS and RS were not. Kaplan-Meier survival analysis with a cut-off of 2SD below the mean LV global LS for the CTRL showed that LV global LS >-13% was significantly associated with all-cause mortality (log rank P=0.011).
Conclusions: In patients with severe PAH and preserved LVEF, LV global LS was significantly reduced, highlighting the importance of subclinical LV dysfunction in these patients, which appears to have an impact on outcomes.
Author Disclosures: K. Kishiki: None. A. Singh: None. A. Narang: None. M. Gomberg-Maitland: None. V. Mor-Avi: None. R.M. Lang: None. K. Addetia: None.
- © 2016 by American Heart Association, Inc.