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Interdependence of right ventricular systolic function and left ventricular filling and its association with outcome for patients with pulmonary hypertension

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Abstract

Although impaired right ventricular (RV) performance has been associated with adverse outcomes for pulmonary hypertension (PH) patients, the relationship between bi-ventricular interdependence and outcomes is not yet fully understood. We studied 96 PH patients. RV systolic function was assessed by means of RV free-wall longitudinal speckle-tracking strain (RV-free), and left ventricular (LV) filling as early diastolic transmitral flow velocity (TMF-E). RV-free ≤19 % and TMF-E <60 cm/s were adopted as pre-defined cut-offs for RV systolic dysfunction and LV under-filling, respectively, associated with worse outcomes. Long-term outcome was tracked over 2.2 years. RV-free correlated significantly with TMF-E (r = 0.57, p < 0.001).TMF-E and RV-free were significantly lower in patients with than in those without cardiac events. RV systolic dysfunction and LV under-filling was observed in 35 patients. These features were associated with worse long-term survival compared to other sub-groups (log-rank p = 0.012). A sequential Cox model based on clinical variables including world health organization functional class IV and brain natriuretic peptide >150 pg/dl (χ2 = 1.2) was improved by the addition of RV-free (χ2 = 5.5, p = 0.04) as well as of TMF-E (χ2 = 11.5, p = 0.01). In conclusions, RV systolic function was shown to correlate significantly with LV filling in PH patients. In addition, not only assessment of RV systolic function, but also of a combined bi-ventricular parameter comprising RV systolic function and LV filling may well have clinical implications for more successful management of PH patients.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Yoshiki Motoji, Hidekazu Tanaka, Yuko Fukuda, Hiroyuki Sano, Keiko Ryo, Junichi Imanishi, Tatsuya Miyoshi, Takuma Sawa, Yasuhide Mochizuki, Kensuke Matsumoto, Noriaki Emoto & Ken-ichi Hirata

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  1. Yoshiki Motoji
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  2. Hidekazu Tanaka
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  3. Yuko Fukuda
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  4. Hiroyuki Sano
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  6. Junichi Imanishi
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  7. Tatsuya Miyoshi
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Correspondence to Hidekazu Tanaka.

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Motoji, Y., Tanaka, H., Fukuda, Y. et al. Interdependence of right ventricular systolic function and left ventricular filling and its association with outcome for patients with pulmonary hypertension. Int J Cardiovasc Imaging 31, 691–698 (2015). https://doi.org/10.1007/s10554-015-0598-x

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  • DOI: https://doi.org/10.1007/s10554-015-0598-x

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