Determinants of altered left ventricular suction in pre-capillary pulmonary hypertension

Yasuyuki Chiba; Hiroyuki Iwano; Satonori Tsuneta; Shingo Tsujinaga; Brett Meyers; Pavlos Vlachos; Suguru Ishizaka; Ko Motoi; Hiroyuki Aoyagi; Yoji Tamaki; Asuka Tanemura; Michito Murayama; Shinobu Yokoyama; Masahiro Nakabachi; Hisao Nishino; Sanae Kaga; Kiwamu Kamiya; Hiroshi Ohira; Ichizo Tsujino; Toshihisa Anzai

doi:10.1093/ehjci/jeab285

Determinants of altered left ventricular suction in pre-capillary pulmonary hypertension

Eur Heart J Cardiovasc Imaging. 2022 Sep 10;23(10):1399-1406. doi: 10.1093/ehjci/jeab285.

Authors

Yasuyuki Chiba¹, Hiroyuki Iwano^{1

2}, Satonori Tsuneta³, Shingo Tsujinaga¹, Brett Meyers⁴, Pavlos Vlachos⁴, Suguru Ishizaka¹, Ko Motoi¹, Hiroyuki Aoyagi¹, Yoji Tamaki¹, Asuka Tanemura⁵, Michito Murayama⁵, Shinobu Yokoyama⁶, Masahiro Nakabachi⁶, Hisao Nishino⁶, Sanae Kaga⁷, Kiwamu Kamiya¹, Hiroshi Ohira^{8

9}, Ichizo Tsujino⁸, Toshihisa Anzai¹

Affiliations

¹ Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
² Division of Cardiology, Hakodate Municipal Hospital, 1-10-1, Minato-cho, Hakodate 041-8680, Japan.
³ Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan.
⁴ School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN 47907-2088, USA.
⁵ Diagnostic Center for Sonography, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan.
⁶ Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo 060-8648, Japan.
⁷ Faculty of Health Sciences, Hokkaido University, Kita-12, Nishi-5, Kita-ku, Sapporo 060-0812, Japan.
⁸ Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
⁹ Division of Cardiology, KKR Sapporo Medical Center, 3-40, Hiragishi 1-6, Toyohira-ku, Sapporo 062-0931, Japan.

PMID: 35019957
DOI: 10.1093/ehjci/jeab285

Abstract

Aims: Although the left ventricular (LV) dysfunction in pre-capillary pulmonary hypertension (PH) has been recently recognized, the mechanism of LV dysfunction in this entity is not completely understood. We thus aimed to elucidate the determinants of intraventricular pressure difference (IVPD), a measure of LV suction, in pre-capillary PH.

Methods and results: Right heart catheterization and echocardiography were performed in 86 consecutive patients with pre-capillary PH (57 ± 18 years, 85% female). IVPD was determined using colour M-mode Doppler to integrate the Euler equation. In overall, IVPD was reduced compared to previously reported value in normal subjects. In univariable analyses, QRS duration (P = 0.028), LV ejection fraction (P = 0.006), right ventricular (RV) end-diastolic area (P < 0.001), tricuspid annular plane systolic excursion (P = 0.004), and LV early-diastolic eccentricity index (P = 0.009) were associated with IVPD. In the multivariable analyses, RV end-diastolic area and LV eccentricity index independently determined the IVPD.

Conclusion: Aberrant ventricular interdependence caused by RV enlargement could impair the LV suction. This study first applied echocardiographic IVPD, a reliable marker of LV diastolic suction, to investigate the mechanism of LV diastolic dysfunction in pre-capillary PH.

Keywords: echocardiography; interventricular dependence; intraventricular pressure difference; pulmonary hypertension.

MeSH terms

Diastole
Female
Heart Ventricles
Humans
Hypertension, Pulmonary* / diagnostic imaging
Hypertension, Pulmonary* / etiology
Male
Suction / adverse effects
Ventricular Dysfunction, Left*
Ventricular Dysfunction, Right*
Ventricular Pressure