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. 2015 Jun;5(2):370-5.
doi: 10.1086/681268.

Abnormal right ventricular relaxation in pulmonary hypertension

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Abnormal right ventricular relaxation in pulmonary hypertension

Stuart D Murch et al. Pulm Circ. 2015 Jun.

Abstract

Left ventricular diastolic dysfunction is a well-described complication of systemic hypertension. However, less is known regarding the effect of chronic pressure overload on right ventricular (RV) diastolic function. We hypothesized that pulmonary hypertension (PHT) is associated with abnormal RV early relaxation and that this would be best shown by invasive pressure measurement. Twenty-five patients undergoing right heart catheterization for investigation of breathlessness and/or suspected PHT were studied. In addition to standard measurements, RV pressure was sampled with a high-fidelity micromanometer, and RV pressure/time curves were analyzed. Patients were divided into a PHT group and a non-PHT group on the basis of a derived mean pulmonary artery systolic pressure of 25 mmHg. Eleven patients were classified to the PHT group. This group had significantly higher RV minimum diastolic pressure ([Formula: see text] vs. [Formula: see text] mmHg, [Formula: see text]) and RV end-diastolic pressure (RVEDP; [Formula: see text] vs. [Formula: see text] mmHg, [Formula: see text]), and RV τ was significantly prolonged ([Formula: see text] vs. [Formula: see text] ms, [Formula: see text]). There were strong correlations between RV τ and RV minimum diastolic pressure ([Formula: see text], [Formula: see text]) and between RV τ and RVEDP ([Formula: see text], [Formula: see text]). There was a trend toward increased RV contractility (end-systolic elastance) in the PHT group ([Formula: see text] vs. [Formula: see text] mmHg/mL, [Formula: see text]) and a correlation between RV systolic pressure and first derivative of maximum pressure change ([Formula: see text], [Formula: see text]). Stroke volumes were similar. Invasive measures of RV early relaxation are abnormal in patients with PHT, whereas measured contractility is static or increasing, which suggests that diastolic dysfunction may precede systolic dysfunction. Furthermore, there is a strong association between measures of RV relaxation and RV filling pressures.

Keywords: diastolic function; heart failure; pulmonary hypertension; right ventricle; right ventricular function.

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Figures

Figure 1
Figure 1
Relationship between right ventricle (RV) τ and RV minimum diastolic pressure (A) and RV end-diastolic pressure (EDP; B). Patients with pulmonary hypertension (PHT) are represented by open blue circles, and patients without PHT are represented by open red circles. Regression lines are shown for patients with PHT (blue), patients without PHT (red), and both groups combined (black).
Figure 2
Figure 2
Relationship between right ventricle systolic pressure (RVSP) and RV first derivative of maximum pressure change (dP/dtmax; A) and relationship between RVSP and RV first derivative of minimum pressure change (dP/dtmin; B). Patients with pulmonary hypertension (PHT) are represented by open blue circles, and patients without PHT are represented by open red circles. Regression lines are shown for patients with PHT (blue), patients without PHT (red), and both groups combined (black).

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