Cardiac remodeling and left ventricular-arterial coupling in patients with chronic thromboembolic pulmonary hypertension

Abstract

Aims: to assess cardiac remodeling and left ventricular-arterial coupling (LVAC) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by 2D echocardiography. Methods: 10 CTEPH patients (6 men and 4 women, mean age 48.9 ± 15.4 years) in WHO functional class II (40%), III (50%), and IV (10%) were included in the study. The patients underwent 2D echocardiography with assessment of right ventricular (RV) and left ventricular (LV) systolic and diastolic function, systolic pulmonary artery pressure (SPAP), LV diastolic eccentricity index, LVAC (ratio of LV end-systolic volume to LV stroke volume). Results: All CTEPH patients had dilated and hypetrophied RV (RV size 3.81 ± 0.68 sm; RV wall thickness (0.64 ± 0.09 sm). 60% of patients had paradoxical interventricular septal motion as a result of RV pressure overload with SPAP 80.3 ± 20.9 mm Hg. Long-term pressure overload resulted in decrease in RV systolic function (TAPSE 1.39 ± 0.38 sm, FAC 26.55 ± 6.83%). RV diastolic function was also impaired: reduced early diastolic tricuspid annulus velocity (TDI) – 40%, impaired relaxation – 10%, pseudonormal filling - 50%. All patients had preserved LV systolic function (LV EF 66.64 ± 4.23%), but in 8 patients we observed an impairment of diastolic function without any causes of increased LV afterload: reduced early diastolic mitral annulus velocity (TDI) – 20%, impaired relaxation – 60%. CTEPH patients also had an increased LV diastolic eccentricity index (1.3 ± 0.2) and a decreased LVAC (0.46 ± 0.16). Conclusions: Long-term RV pressure overload resulted in impairment of LV diastolic function and decreased LVAC may be due to interventricular interaction.