Pulmonary artery pressure and diastolic dysfunction in normal left ventricular systolic function

Pulmonary arterial hypertension is a well-established sequel of LV systolic dysfunction; however its association with diastolic dysfunction in subjects with normal LV systolic function has not been thoroughly studied. The aim of this study was to evaluate the correlation between diastolic dysfunction and pulmonary arterial hypertension in patients with normal left ventricular (LV) wall motion.

We analyzed retrospectively 477 consecutive echocardiographic studies that were performed in the Meir Medical Center echocardiography laboratory in subjects with normal LV systolic function and correlated the state of diastolic function (normal, impaired relaxation, pseudo normal and restrictive pattern) to the magnitude of pulmonary artery pressure (PAP) assessed by echocardiography. None of the subjects that were studied had any other established causes of pulmonary hypertension.

Mean PAP for subjects with normal diastolic function (n=110) was 31.1+/-6 mm Hg; for grade 1 diastolic dysfunction (impaired relaxation ) (n=256) 35.6+/-10.2 mm Hg; for grade 2 (pseudo normal) (n=102) 38.9=10.6 mm Hg and for grade 3 (restrictive pattern) (n=9) the pressure was 55.1+/-11.4 mm Hg (p<0.001 by one-way ANOVA, the differences were between each 2 groups of diastolic dysfunction).

LV diastolic dysfunction is associated with an increase in PAP in subjects with normal systolic function. PAP is significantly increased for each step-up in diastolic dysfunction grade.