Abstract
Background: Left ventricular diastolic dysfunction (LVDD) associated with left ventricular hypertrophy (LVH) has been reported to play a major role in cardiovascular heart failure. Although, right ventricular diastolic dysfunction (RVDD) in patients with LVH was known to be clinically relevant, no systematic study had been performed regarding this relationship between left ventricular (LV) geometry associated with LVH and RVDD. The goal of this study was to evaluate an association between RVDD; LVDD, LVH and LV altered geometry for early diagnosis of heart failure. Methods and Results: Out of 426 patients, 396 patients (93%) were found to have both RVDD and LVDD. In this cohort, LV concentric geometry (LVCG) was identified in 138 patients (32.3%). RVDD and LVDD were diagnosed by measurement of E/A and tissue doppler imaging (E’/A’) for mitral and tricuspid valves. The mean value of mitral E/A in the LVCG group was lower than that of controls; 0.63±0.03 vs. 1.44±0.03, p<0.02. Mitral E’/A’ was also lower in LVCG than that of controls; 0.60±0.02 vs. 1.36±0.03, p<0.01. Similarly, E/A of Tricuspid valve in patients with LVCG was found to be lower than E/A of Tricuspid valve of controls; 0.52±0.07 vs. 0.69±0.02, p<0.001 and E’/A’ of tricuspid valve was lower than that of controls; 0.44±0.02 vs. 0.63±0.06, p<0.05. Conclusions: This study demonstrated that simple doppler trans-valvular inflow parameters and tissue doppler imaging may identify patients with biventricular diastolic dysfunction. This finding was more often observed in patients with LV concentric geometry, a pattern associated with an increased risk of cardiovascular events.
Highlights
Left ventricular diastolic dysfunction (LVDD) associated with left ventricular hypertrophy (LVH) has been reported to play a major role in cardiovascular heart failure
RV diastolic dysfunction and LV diastolic dysfunction were assessed by above mentioned criteria, the values of E/A and E/A and tissue doppler imaging (E’/A)’ at both mitral valve (MV) and tricuspid valve (TV) inflow are summarized in the (Table 2)
E/A of tricuspid valve was lower in LV concentric geometry (LVCG) than normal geometry with normal mass (NGNM) group; E/A 0.52±0.07 vs. 0.67±0.05, p
Summary
Left ventricular diastolic dysfunction (LVDD) associated with left ventricular hypertrophy (LVH) has been reported to play a major role in cardiovascular heart failure. Right ventricular diastolic dysfunction (RVDD) in patients with LVH was known to be clinically relevant, no systematic study had been performed regarding this relationship between left ventricular (LV) geometry associated with LVH and RVDD. The common denominator for LV and RV function is the septum which constitutes 40% of LV mass Both the ventricles are bound together by spiral muscle bundles of the septum that encircle them in a complex interlacing fashion making LV and RV highly interdependent. Due to this interdependence, RV dysfunction associated with altered LV geometry and LVDD may play a role in heart failure morbidity and mortality. This study was designed to assess relationship between LV geometry, mass and RVDD and their interdependence mediated by the unique structure of the septum
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