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Underfilling decreases left ventricular function in pulmonary arterial hypertension
Hannah Sjögren1, Barbro Kjellström1,2, Anna Bredfelt1
1Department of Clinical Sciences Lund, Clinical Physiology and Skåne University Hospital, Lund University, Lund, Sweden.
The International Journal of Cardiovascular Imaging
|January 27, 2021
Summary
Impaired left ventricular (LV) function in pulmonary arterial hypertension (PAH) is linked to LV underfilling, not intrinsic dysfunction. This study found reduced LV function correlated with smaller LV volumes and atrial volumes, suggesting underfilling as the primary mechanism.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Pulmonary Hypertension
Background:
- Pulmonary arterial hypertension (PAH) can affect left ventricular (LV) function.
- The relationship between LV longitudinal function and LV filling status in PAH is not fully understood.
Purpose of the Study:
- To investigate the association between impaired LV longitudinal function and LV underfilling in patients with PAH.
- To differentiate between underfilling and intrinsic LV dysfunction as causes of impaired LV function in PAH.
Main Methods:
- Cardiac magnetic resonance (CMR) imaging was used to assess LV and left atrial volumes (LAV).
- LV longitudinal function was evaluated using atrio-ventricular plane displacement (AVPD) and global longitudinal strain (GLS).
- Right heart catheterisation measured pulmonary artery wedge pressure (PAWP).
Main Results:
- Patients with PAH exhibited smaller LAV, LV volumes, and stroke volumes compared to controls.
- Impaired LV longitudinal function (lower AVPD and GLS) was observed in PAH patients.
- LV stroke volume, AVPD, GLS, and LAVmax were significantly correlated, but none correlated with PAWP, indicating normal left atrial pressures.
Conclusions:
- Impaired LV longitudinal function in PAH is associated with low stroke volume and small left atrial volume, suggesting LV underfilling.
- The findings imply that LV underfilling, rather than intrinsic LV dysfunction, is the primary mechanism for reduced LV longitudinal function in PAH.
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