Patterns of the Interventricular Septal Motion Can Predict Conditions of Patients with Pulmonary Hypertension

Abstract

We sought to investigate the clinical and hemodynamic implications of interventricular septal motion in patients with pulmonary hypertension. In patients with pulmonary hypertension, we have noticed two types of peculiar motions of the interventricular septum by M-mode echocardiography: marked early systolic anterior motion (type A) and marked early diastolic posterior motion (type B). We performed echocardiography on 32 patients (age 42 +/- 13 years) with pulmonary hypertension within 1 week of cardiac catheterization. Type A was found in 14 patients (group A) and type B was found in 18 patients (group B). There was no difference between two groups in left ventricular eccentricity index at early diastole (2.4 +/- 0.6 vs 2.1 +/- 0.7) and mean pulmonary arterial pressure (54 +/- 10 vs 53 +/- 13 mm Hg). However, New York Heart Association functional class (2.7 +/- 0.4 vs 2.2 +/- 0.3) and serum levels of brain natriuretic peptide (271 +/- 155 vs 74 +/- 55 pg/mL) were significantly higher and cardiac index (1.7 +/- 0.3 vs 2.3 +/- 0.4 L/min/m(2)) was significantly lower in group A (P < .001). Simultaneous recordings of both ventricular pressures showed that right ventricular pressure was higher than left ventricular pressure during whole diastole in group A, but in group B, during only early diastole. By multiple linear regression analysis, type A motion independently predicted low cardiac index. Interventricular septal motion could predict patients' conditions. Patients with type A motion were more morbid clinically and hemodynamically than patients with type B motion.