Abnormal right ventricular relaxation in pulmonary hypertension.

ABSTRACT

Left ventricular diastolic dysfunction is a well-described complication of systemic hypertension. However, less is known regarding the effect of chronic pressure overload on right ventricular (RV) diastolic function. We hypothesized that pulmonary hypertension (PHT) is associated with abnormal RV early relaxation and that this would be best shown by invasive pressure measurement. Twenty-five patients undergoing right heart catheterization for investigation of breathlessness and/or suspected PHT were studied. In addition to standard measurements, RV pressure was sampled with a high-fidelity micromanometer, and RV pressure/time curves were analyzed. Patients were divided into a PHT group and a non-PHT group on the basis of a derived mean pulmonary artery systolic pressure of 25 mmHg. Eleven patients were classified to the PHT group. This group had significantly higher RV minimum diastolic pressure ([Formula see text] vs. [Formula see text] mmHg, [Formula see text]) and RV end-diastolic pressure (RVEDP; [Formula see text] vs. [Formula see text] mmHg, [Formula see text]), and RV τ was significantly prolonged ([Formula see text] vs. [Formula see text] ms, [Formula see text]). There were strong correlations between RV τ and RV minimum diastolic pressure ([Formula see text], [Formula see text]) and between RV τ and RVEDP ([Formula see text], [Formula see text]). There was a trend toward increased RV contractility (end-systolic elastance) in the PHT group ([Formula see text] vs. [Formula see text] mmHg/mL, [Formula see text]) and a correlation between RV systolic pressure and first derivative of maximum pressure change ([Formula see text], [Formula see text]). Stroke volumes were similar. Invasive measures of RV early relaxation are abnormal in patients with PHT, whereas measured contractility is static or increasing, which suggests that diastolic dysfunction may precede systolic dysfunction. Furthermore, there is a strong association between measures of RV relaxation and RV filling pressures.