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Updated: Jul 16, 2026

Pulsed Wave Doppler Assessment of Diastolic Dysfunction in the ZSF-1 Rat Model of Pulmonary Hypertension Due to Left Heart Disease
Published on: May 22, 2026
Abnormal left ventricular diastolic filling in chronic thromboembolic pulmonary hypertension: true diastolic
Swaminatha V Gurudevan1, Philip J Malouf, William R Auger
1Division of Cardiology, University of California Irvine School of Medicine, Irvine, California, USA.
Insights
Abnormal left ventricular (LV) filling in chronic thromboembolic pulmonary hypertension (CTEPH) is primarily due to low LV preload and underfilling, not chamber distortion. Pulmonary thromboendarterectomy (PTE) improves LV diastolic function by increasing preload.
Area of Science:
- Cardiology
- Pulmonary Hypertension
- Echocardiography
Background:
Purpose of the Study:
- To investigate the underlying cause of abnormal LV Doppler diastolic filling characteristics in patients with CTEPH.
- To determine if RV enlargement and LV distortion or low LV preload are responsible for the observed diastolic dysfunction.
Main Methods:
- Studied 61 patients with CTEPH and an E
- Compared pre- and postoperative transthoracic echocardiography and right heart catheterization measurements.
Main Results:
- Following PTE, mitral E velocity increased, A velocity decreased, and E/A ratio normalized, indicating improved LV inflow.
- Pulmonary venous velocities increased, and LV septal and posterior wall thickness remained unchanged, ruling out geometric changes as the primary cause.
- Mean pulmonary capillary wedge pressure increased post-PTE, suggesting improved LV preload.
Conclusions:
- The impaired relaxation pattern in CTEPH is largely caused by low LV preload and relative underfilling, rather than solely by geometric effects of RV enlargement and LV chamber distortion.
- Pulmonary thromboendarterectomy effectively improves LV diastolic function by addressing the issue of low preload.
Objectives:
The purpose of this study was to investigate the cause of abnormal left ventricular (LV) Doppler diastolic filling characteristics in chronic thromboembolic pulmonary hypertension (CTEPH).
Background:
Results:
After PTE, mitral E velocity increased (from 54 +/- 16 cm/s to 81 +/- 20 cm/s, p < 0.001), whereas A velocity decreased (77 +/- 22 cm/s to 71 +/- 20 cm/s, p < 0.001). E/A ratio normalized (0.72 +/- 0.16 cm/s to 1.22 +/- 0.40 cm/s, p < 0.001). Pulmonary venous systolic and diastolic velocities both increased (57 +/- 13 cm/s to 68 +/- 16 cm/s and 39 +/- 15 cm/s to 70 +/- 21 cm/s, respectively, p < 0.001 for both). Diastolic velocity of the septal mitral annulus (E(m)) did not change after PTE (8.0 +/- 3.1 cm/s to 8.1 +/- 2.0 cm/s, p = ns), whereas the velocity of the lateral mitral annulus increased (9.3 +/- 3.2 cm/s to 11.8 +/- 3.1 cm/s, p < 0.001). Mean pulmonary capillary wedge pressure increased from 9.3 +/- 3.2 mm Hg to 10.6 +/- 3.8 mm Hg (p = 0.035). Despite these marked changes in LV inflow, M-mode measurements of LV septal and posterior wall thickness were normal before PTE and did not change after surgery (septal: 10 +/- 2 mm vs. 10 +/- 1 mm; posterior: 10 +/- 2 mm vs. 10 +/- 1 mm; p = NS for both comparisons).
Conclusions:
The results of this study strongly suggest that the impaired relaxation pattern observed in patients with CTEPH is not solely the result of geometric effects of RV enlargement and LV chamber distortion but is caused in large part by low LV preload and relative underfilling.
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