Different patterns of adaptation of the right ventricle to pressure overload: a comparison between pulmonary hypertension and pulmonary stenosis.

Abstract

BACKGROUND:

The study was designed to compare RV morphological and functional parameters derived from conventional and myocardial deformation echocardiography in two instances of right heart pressure overload: pulmonary arterial hypertension (PAH) and pulmonary stenosis (PS).

METHODS:

Sixty-two individuals were included: 22 patients with pulmonary arterial hypertension (PAH), 19 patients with PS and 21 healthy individuals who served as a control group. All patients had clinical evaluation with 6-minute walking test, standard and two-dimensional strain echocardiography and B-type natriuretic peptide evaluation.

RESULTS:

At similar levels of pressure overload (RV systolic pressure, 88.2 ± 31.5 vs 73.4 ± 34.9 mm Hg; P = NS) the right ventricles of patients with PS were less dilated (RV end-diastolic diameter, 31.7 ± 3.7 vs 43.7 ± 10.5 mm; P < .001) and performed significantly better than those of patients with PAH (RV strain, -27.4 ± 5.8% vs 16.2 ± 7.9%; RV fractional area change, 51.1 ± 9.2% vs 29.1 ± 11.3%; P < .001). Although some of the RV functional parameters were comparable with those in healthy individuals, strain rate showed lower values, suggesting subclinical longitudinal dysfunction in patients with PS. Myocardial stress biomarkers were correlated with RV systolic pressure only in patients with PAH (r = 0.64, P = .03), not in those with PS (r = 0.22, P = .50).

CONCLUSIONS:

At similar levels of pressure overload, the right ventricle is less dilated and performs better in patients with PS compared with those with PAH.

• Authors: Ruxandra Jurcut, Sorin Giusca, Razvan Ticulescu, Elena Popa, Mihaela-Silvia Amzulescu, Ioana Ghiorghiu, Ioan Mircea Coman, Bogdan Alexandru Popescu, Jens-Uwe Voigt, Carmen Ginghina
• Journal: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography (J Am Soc Echocardiogr) Vol. 24 Issue 10 Pg. 1109-17 (Oct 2011) ISSN: 1097-6795 [Electronic] United States
• PMID: 21873027 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adaptation, Physiological
• Adult
• Diagnosis, Differential
• Disease Progression
• Echocardiography, Doppler
• Female
• Heart Ventricles (diagnostic imaging, physiopathology)
• Humans
• Hypertension, Pulmonary (complications, diagnostic imaging, physiopathology)
• Hypertrophy, Right Ventricular (diagnostic imaging, etiology, physiopathology)
• Male
• Myocardial Contraction
• Pulmonary Valve Stenosis (complications, diagnostic imaging, physiopathology)
• Ventricular Function, Right (physiology)
• Ventricular Pressure (physiology)