Ventricular Geometry, Strain, and Rotational Mechanics in Pulmonary Hypertension
Open accessAbstract
Background— We tested the hypothesis that right ventricular (RV) pressure overload affects RV function and further influences left ventricular (LV) geometry, which adversely affects LV twist mechanics and segmental function. Methods and Results— Echocardiographic images were prospectively acquired in 44 patients (age, 46±12 years; 82% women) with evidence of pulmonary hypertension (estimated pulmonary artery systolic pressure, 71±23 mm Hg) and in 44 age- and gender-matched healthy subjects. Patients with intrinsic LV diseases were excluded. RV lateral wall longitudinal strain (LS) and interventricular septal (IVS) LS were reduced in the pulmonary hypertension group compared with control subjects (−15.9±7.6% versus −25.5±6.1%, P <0.001; and −17.3±4.4% versus −20.2±3.9%, P =0.002, respectively), whereas LV lateral wall LS was preserved. RV lateral wall LS and IVS LS, but not LV lateral wall LS, correlated with pulmonary artery systolic pressure ( r =0.56, P <0.01; r =0.32, P <0.01) and LV eccentricity index ( r =0.57, P <0.01; r =0.57, P <0.01). IVS and LV lateral wall circumferential strain (CS) were both reduced in the pulmonary hypertension group. Although IVS CS and LV lateral wall CS correlated with pulmonary artery systolic pressure and LV eccentricity index, after adjustment of CS for LV eccentricity index, differences between groups persisted for IVS CS ( P <0.01) but not LV lateral wall CS ( P =0.09). LV torsion was decreased in patients with pulmonary hypertension compared with control subjects (9.6±4.9° versus 14.7±4.9°, P <0.001). LV torsion inversely correlated with pulmonary artery systolic pressure ( r =−0.39, P <0.01) and LV eccentricity index ( r =−0.3, P <0.01). LV untwisting rates were similar in both groups ( P =0.7). Conclusions— Chronic RV pressure overload directly affects RV longitudinal systolic deformation. RV pressure overload further influences IVS and LV geometry, which impairs LV torsion and segmental LS and CS, more for the IVS than for the free wall of the LV.
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- Authors
- Puwanant, S., Park, M., Popović, Z. B., Tang, W. H. W., Farha, S., George, D., Sharp, J., Puntawangkoon, J., Loyd, J. E., Erzurum, S. C., & Thomas, J. D.
- Affiliations
- Thai Red Cross Society (TH)
- From the Department of Cardiovascular Medicine (S.P., M.P., Z.B.P., W.H.W.T., J.P., J.D.T.), Respiratory Institute (S.F., D.G., J.S., S.C.E.), and Department of Pathobiology (S.C.E.), Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Pulmonary Medicine, Vanderbilt University School of Medicine, Nashville, Tenn (J.E.L.); and Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society,...
- ORCID
- Venue
- Circulation
- Published
- 2010-01-19
- Volume
- 121
- Issue
- 2
- Pages
- 259-266
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC2846516
- OpenAlex
- W2113003320
- Cited by
- 240
- References
- 30
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 8 · 2022: 15 · 2021: 16 · 2020: 9 · 2019: 19 · 2018: 14 · 2017: 17 · 2016: 17 · 2015: 14 · 2014: 34 · 2013: 16 · 2012: 22
- FWCI
- 14.05
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Aeronautics and Space Administration (NASA NCC 9‐58)
- National Space Biomedical Research Institute (NASA NCC 9‐58, NCC 9‐58)
- Georgia Clinical and Translational Science Alliance
- National Institutes of Health (NCC9-58)
- National Heart, Lung, and Blood Institute (HL-60917, U10HL109250, R37HL060917, R01HL060917)
- National Center for Research Resources (RR 024989, UL1RR024989)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Pulmonary Hypertension Research and Treatments
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Keywords
- pulmonary hypertension, right ventricular pressure overload, right ventricular longitudinal strain, left ventricular torsion, pulmonary artery systolic pressure, right ventricular function, myocardial deformation
- MeSH terms
- Adult, Biomechanical Phenomena, Electrocardiography, Female, Heart Ventricles, Humans, Hypertension, Pulmonary, Male, Middle Aged, Prospective Studies, Pulmonary Artery, Case-Control Studies, Ventricular Dysfunction, Left, Ventricular Dysfunction, Right
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