Pulmonary hypertension affects left ventricular basal twist: a novel use for speckle-tracking imaging

Chronic pulmonary hypertension (PH) results in right ventricular (RV) mechanical dyssynchrony. However, its effects on left ventricular (LV) mechanics have not been examined.

Since speckle-tracking echocardiography (STE) is a novel approach to quantify LV dyssynchrony; we decided to use STE to assess the effect of PH on LV mechanics.

Our echocardiography database was queried for patients with PH who had undergone STE analysis and compared to similarly collected data from a group of healthy volunteers.

Group I (15 patients, age of 53 +/- 17 years, pulmonary artery pressure of 62 +/- 20 mmHg, eccentricity index of 0.78 +/- 0.06, and LV ejection fraction of 64 +/- 11%) and Group II (8 healthy volunteers, age 41 +/- 9 years, pulmonary artery pressure 14.6 +/- 4.2 mmHg, eccentricity index of 1.02 +/- 0.05, and LV ejection fraction of 66 +/- 6 mmHg). There was no difference in QRS duration between the two groups. Although PH significantly altered basal LV twist (Group I: M =-5.76 degrees versus Group II: M =-1.82 degrees , P < 0.05), it had no effect on LV apical twist (5.29 degrees versus 4.50 degrees ; P = NS, respectively). More notably, significant LV radial basal LV dyssynchrony, measured as the time to peak LV basal twist, was seen as a result of PH.

STE identifies the presence of LV dyssynchrony in PH despite normal LV ejection fraction and no difference in QRS duration. Additional studies are now required to further characterize these results and determine their prognostic significance.