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CLINICAL STUDY: ECHOCARDIOGRAPHY

Correlation of left ventricular diastolic filling characteristics with right ventricular overload and pulmonary artery pressure in chronic thromboembolic pulmonary hypertension

^* Division of Cardiology, University of California, San Diego School of Medicine, San Diego, California, USA

Manuscript received August 30, 2001; revised manuscript received March 29, 2002, accepted April 17, 2002.

^* Reprint requests and correspondence: Dr. Daniel G. Blanchard, UCSD Medical Center, Division of Cardiology, 200 West Arbor Drive, San Diego, California 92103-8411, USA.
dblanchard{at}ucsd.edu

OBJECTIVES: This study was designed to determine a quantitative relationship between right ventricular (RV) pressure overload and left ventricular (LV) diastolic filling characteristics in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

BACKGROUND: Right ventricular pressure overload in patients with CTEPH causes abnormal LV diastolic filling. However, a quantitative relationship between RV pressure overload and LV diastolic function has not been established.

METHODS: We analyzed pre- and postoperative diastolic mitral inflow velocities and right heart hemodynamic data in 39 consecutive patients with CTEPH over the age of 30 (55 ± 11 years) with mean pulmonary artery pressure >30 mm Hg who underwent pulmonary thromboendarterectomy (PTE).

RESULTS: After PTE, mean pulmonary artery pressure (mPAP) decreased from 50 ± 11 to 28 ± 9 mm Hg (p < 0.001) while cardiac output (CO) increased from 4.4 ± 1.1 to 5.7 ± 0.9 l/m (p < 0.001). Mitral E/A ratio (E/A) increased from 0.74 ± 0.22 to 1.48 ± 0.69 (p < 0.001). E/A was < 1.25 in all patients pre-PTE. After PTE, all patients with E/A >1.50 had mPAP <35 mm Hg and CO >5.0 l/min. E/A correlated inversely with mPAP (r = 0.55, p < 0.001) and directly with CO (r = 0.53, p < 0.001).

CONCLUSIONS: E/A is consistently abnormal in patients with CTEPH and increases post-PTE. Moreover, E/A varies inversely with mPAP and directly with CO. Following PTE, E/A >1.5 correlates with the absence of severe pulmonary hypertension (mPAP >35 mm Hg) and the presence of normal cardiac output (> 5.0 l/m).

Abbreviations and Acronyms   CO   cardiac output   CTEPH   chronic thromboembolic pulmonary hypertension   DT   deceleration time   E/A   E/A ratio   LV   left ventricular   mPAP   mean pulmonary artery pressure   PA   pulmonary artery   PCWP   pulmonary capillary wedge pressure   PHT   pressure half-time   PTE   pulmonary thromboendarterectomy   PVR   pulmonary vascular resistance   RV   right ventricular

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