This study sought to characterize mechanical activation in pulmonary arterial hypertension
(PAH) using 2-dimensional echocardiography with tissue Doppler imaging. Whether pathologic
alterations of the right ventricle in PAH affect interventricular dyssynchrony due
to changes in mechanical activation of the septum and the right ventricle is unclear.
We studied 20 patients with PAH (14 women, mean age 55 ± 16 years) and 20 healthy
controls (15 women, mean age 41 ± 11 years) that underwent tissue Doppler imaging
between July 2006 and May 2007. PAH was associated with accelerated right ventricular
(RV) (p <0.0001) and septal (p = 0.022) activation times, but no differences were
found in lateral wall activation times between groups (p = 0.35). Measures of ventricular
dyssynchrony indicated that patients with PAH had significantly lower RV-lateral wall
delays (patients 3.2 ± 66.2 ms vs controls 56.7 ± 52.0 ms, p = 0.007), reflecting
a faster activation of the right ventricle relative to the lateral wall than controls.
In conclusion, PAH is associated with interventricular dyssynchrony manifested by
accelerated RV free wall and septal activation times. Whether such dyssynchrony should
serve as a therapeutic target remains to be determined.
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References
- New method for evaluating left ventricular wall motion by color-coded tissue Doppler imaging: in vitro and in vivo studies.J Am Coll Cardiol. 1995; 25: 717-724
- American Society of Echocardiography recommendations for use of echocardiography in clinical trials.J Am Soc Echocardiogr. 2004; 17: 1086-1119
- The effect of right ventricular dysfunction on left ventricular form and function.Chest. 2001; 119: 1632-1633
- Tissue Doppler imaging and left ventricular dyssynchrony in heart failure.J Card Fail. 2006; 12: 154-162
- Role of tissue Doppler and strain echocardiography in current clinical practice.Circulation. 2007; 116: 2597-2609
- Relation of right ventricular free wall mechanical delay to right ventricular dysfunction as determined by tissue Doppler imaging.Am J Cardiol. 2005; 96: 602-606
- Right ventricular dyssynchrony in patients with pulmonary hypertension is associated with disease severity and functional class.Cardiovasc Ultrasound. 2005; 3: 23
- Interventricular mechanical asynchrony in pulmonary arterial hypertension: left-to-right delay in peak shortening is related to right ventricular overload and left ventricular underfilling.J Am Coll Cardiol. 2008; 51: 750-757
- Heart inefficiency in pulmonary hypertension: a double jeopardy.J Am Coll Cardiol. 2008; 51: 758-759
Article info
Publication history
Published online: September 01, 2008
Accepted:
June 17,
2008
Received in revised form:
June 17,
2008
Received:
May 27,
2008
Footnotes
Dr. Myung H. Park is a consultant and serves on the speaker's bureau for Actelion Pharmaceuticals, Gilead, and United Therapeutics.
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
