Delayed tricuspid valve ascent and descent components in pulmonary hypertension

Even though pulmonary hypertension (PH) results in right ventricular (RV) dilatation and contractile dysfunction; the exact mechanism(s) remain to be identified. RV fractional area change (RVFAC), right atrial (RA) areas, tricuspid annular plane systolic excursion (TAPSE), and systolic (sEI) eccentricity index were measured in 19 PH patients and 11 individuals without PH. Furthermore, time to maximal peak (tmp) TV annular ascent and descent intervals were obtained and corrected for heart rate. Finally, P wave and QRS interval durations as well as heart rates were also measured. As expected, PH results in lower RVFAC and TAPSE, smaller sEI and larger RA areas. More interestingly, longer P wave and QRS durations without significant difference in heart rate are noted in PH patients. Similarly, it took longer to reach maximal TV annular ascent as well as annular descent in PH patients than in those patients without PH. PH significantly prolongs both electrical as well as mechanical events related to annular motion, implying that PH contributes to increased atrial as well ventricular activation times. The nature of this functional coupling between RA and RV necessitates further study.