Underfilling decreases left ventricular function in pulmonary arterial hypertension.
Hannah SjögrenBarbro KjellströmAnna BredfeltKatarina Steding-EhrenborgGöran RådegranRoger HesselstrandHåkan ArhedenEllen OstenfeldPublished in: The international journal of cardiovascular imaging (2021)
To evaluate the association between impaired left ventricular (LV) longitudinal function and LV underfilling in patients with pulmonary arterial hypertension (PAH). Thirty-nine patients with PAH and 18 age and sex-matched healthy controls were included. LV volume and left atrial volume (LAV) were delineated in short-axis cardiac magnetic resonance (CMR) cine images. LV longitudinal function was assessed from atrio-ventricular plane displacement (AVPD) and global longitudinal strain (GLS) was assessed using feature tracking in three long-axis views. LV filling was assessed by LAV and by pulmonary artery wedge pressure (PAWP) using right heart catheterisation. Patients had a smaller LAV, LV volume and stroke volume as well as a lower LV-AVPD and LV-GLS than controls. PAWP was 6 [IQR 5--9] mmHg in patients. LV ejection fraction did not differ between groups. LV stroke volume correlated with LV-AVPD (r = 0.445, p = .001), LV-GLS (r = - 0.549, p < 0.0001) and LAVmax (r = .585, p < 0.0001). Furthermore, LV-AVPD (r = .598) and LV-GLS (r = - 0.675) correlated with LAVmax (p < 0.0001 for both). Neither LV-AVPD, LV-GLS, LAVmax nor stroke volume correlated with PAWP. Impaired LV longitudinal function was associated with low stroke volume, low PAWP and a small LAV in PAH. Small stroke volumes and LAV, together with normal LA pressure, implies that the mechanism causing reduced LV longitudinal function is underfilling rather than an intrinsic LV dysfunction in PAH.
Keyphrases
- pulmonary arterial hypertension
- ejection fraction
- pulmonary artery
- left ventricular
- atrial fibrillation
- magnetic resonance
- left atrial
- heart failure
- aortic stenosis
- coronary artery
- machine learning
- magnetic resonance imaging
- coronary artery disease
- cross sectional
- oxidative stress
- prognostic factors
- acute myocardial infarction
- mitral valve
- aortic valve
- percutaneous coronary intervention
- cerebral ischemia
- cardiac resynchronization therapy
- patient reported