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Am J Physiol Heart Circ Physiol (November 11, 2005). doi:10.1152/ajpheart.01031.2005
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Submitted on September 29, 2005
Accepted on November 10, 2005

Impaired left ventricular filling due to right to left ventricular interaction in patients with pulmonary arterial hypertension

Tji-Joong C Gan1, Jan-Willem Lankhaar1, Tim J Marcus2, Nico Westerhof3, Koen M Marques4, Jean G Bronzwaer4, Anco Boonstra1, Pieter E Postmus1, and Anton Vonk-Noordegraaf1*

1 Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands
2 Fysics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
3 Physiology, VU University Medical Center, Amsterdam, The Netherlands
4 Cardiology, VU University Medical Center, Amsterdam, The Netherlands

* To whom correspondence should be addressed. E-mail: a.vonk{at}vumc.nl.

Aims: To investigate the contribution of direct right to left ventricular interaction on left ventricular filling and stroke volume in pulmonary arterial hypertension (PAH) patients. Methods and Results: Forty-six PAH patients and 18 control subjects were included. Magnetic resonance imaging measured stroke volume, right and left ventricular volumes, left ventricular filling rate and interventricular septum curvature. Transesophageal echocardiography measured left atrial filling. Compared to control subjects, PAH patients had decreased stroke volume (28 ± 13 vs. 41 ± 10 ml/m2, p<0.001), left ventricular end-diastolic volume (46 ± 14 vs. 61 ± 14 ml/m2, p<0.001) and left ventricular peak filling rate (216 ± 90 vs. 541 ± 248 ml/s, p<0.001). Among PAH patients stroke volume did not correlate to right ventricular end-diastolic volume or mean pulmonary artery pressure, but did correlate to left ventricular end-diastolic volume (r = 0.62, p< 0.001). Leftward interventricular septum curvature was correlated to left ventricular filling rate (r = 0.64, p < 0.001) and left ventricular end-diastolic volume (r = 0.65, p< 0.001). In contrast, left atrial filling was normal and not correlated to left ventricular end-diastolic volume. Conclusion: In PAH patients ventricular interaction mediated by the interventricular septum impairs left ventricular filling contributing to decreased stroke volume.




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