Septal Curvature Is Marker of Hemodynamic, Anatomical, and Electromechanical Ventricular Interdependence in Patients with Pulmonary Arterial Hypertension

• Published in: Echocardiography (Mount Kisco, N.Y.) N.Y.), 2014-07, Vol.31 (6), p.699-707
• Main Authors: Haddad, Francois, Guihaire, Julien, Skhiri, Mehdi, Denault, Andre Y., Mercier, Olaf, Al-Halabi, Shadi, Vrtovec, Bojan, Fadel, Elie, Zamanian, Roham T., Schnittger, Ingela
• Format: Article
• Language: English
• Subjects: Blood Flow Velocity; Blood Pressure; Echocardiography, Doppler - methods; Female; heart failure; Heart Septum - diagnostic imaging; Heart Septum - physiopathology; Humans; Hypertension, Pulmonary - complications; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - physiopathology; Image Interpretation, Computer-Assisted - methods; imaging; inter-ventricular dependence; Male; Middle Aged; pulmonary hypertension; Reproducibility of Results; Sensitivity and Specificity; septum; Stroke Volume; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - physiopathology
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.12468

Aims The objective of this study was to determine the factors independently associated with septal curvature in patients with pulmonary arterial hypertension (PAH). Methods Eighty‐five consecutive patients with PAH who had an echocardiogram and a right heart catheterization within 24 hours of each others were included in the study. Septal curvature was assessed at the mid‐papillary level using the eccentricity index (EI). Marked early systolic septal anterior motion was defined as a change in EI > 0.2 between end‐diastole and early systole. Inter‐ventricular mechanical delay was calculated as the percent time difference between right ventricular (RV) to left ventricular (LV) end‐ejection time normalized for the RR interval. Results Average age was 45 ± 11 years and the majority of patients were women (75%). Mean right atrial pressure was 11 ± 7 mmHg, mean PAP was 52 ± 13 mmHg, relative RV area 1.8 ± 0.9, and RV fractional area change 24 ± 8%. End‐diastolic EI was 1.6 ± 0.4 and systolic EI was 2.5 ± 0.8. On multivariate analysis relative pulmonary pressure, relative RV area, and inter‐ventricular mechanical delay were independently associated with systolic EI (R2 = 0.72, P