Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May;37(5):1745-1755.
doi: 10.1007/s10554-020-02143-6. Epub 2021 Jan 27.

Underfilling decreases left ventricular function in pulmonary arterial hypertension

Hannah Sjögren  1 , Barbro Kjellström  1   2 , Anna Bredfelt  1 , Katarina Steding-Ehrenborg  1   3 , Göran Rådegran  4 , Roger Hesselstrand  5 , Håkan Arheden  1 , Ellen Ostenfeld  6   7
Affiliations

Underfilling decreases left ventricular function in pulmonary arterial hypertension

Hannah Sjögren et al. Int J Cardiovasc Imaging. 2021 May.

Abstract

To evaluate the association between impaired left ventricular (LV) longitudinal function and LV underfilling in patients with pulmonary arterial hypertension (PAH). Thirty-nine patients with PAH and 18 age and sex-matched healthy controls were included. LV volume and left atrial volume (LAV) were delineated in short-axis cardiac magnetic resonance (CMR) cine images. LV longitudinal function was assessed from atrio-ventricular plane displacement (AVPD) and global longitudinal strain (GLS) was assessed using feature tracking in three long-axis views. LV filling was assessed by LAV and by pulmonary artery wedge pressure (PAWP) using right heart catheterisation. Patients had a smaller LAV, LV volume and stroke volume as well as a lower LV-AVPD and LV-GLS than controls. PAWP was 6 [IQR 5--9] mmHg in patients. LV ejection fraction did not differ between groups. LV stroke volume correlated with LV-AVPD (r = 0.445, p = .001), LV-GLS (r = - 0.549, p < 0.0001) and LAVmax (r = .585, p < 0.0001). Furthermore, LV-AVPD (r = .598) and LV-GLS (r = - 0.675) correlated with LAVmax (p < 0.0001 for both). Neither LV-AVPD, LV-GLS, LAVmax nor stroke volume correlated with PAWP. Impaired LV longitudinal function was associated with low stroke volume, low PAWP and a small LAV in PAH. Small stroke volumes and LAV, together with normal LA pressure, implies that the mechanism causing reduced LV longitudinal function is underfilling rather than an intrinsic LV dysfunction in PAH.

Keywords: Cardiac magnetic resonance imaging; Feature tracking strain; Left atrial volume; Left ventricular dysfunction; Pulmonary hypertension.

PubMed Disclaimer

Conflict of interest statement

None of the authors have any conflict of interest related to this manuscript.

Figures

Fig. 1
Fig. 1
Example of myocardial tracing in 3-chamber view (left) and delineation of left atrium (right) in a patient with associated pulmonary arterial hypertension owing to systemic sclerosis
Fig. 2
Fig. 2
Correlation between peak systolic left ventricular global longitudinal strain (GLS) and left atrial (LA) volumes in healthy controls (blue circles) and patients with pulmonary arterial hypertension (red filled circles; light red are idiopathic and dark red are associated to systemic sclerosis). LAVmax LA maximum volume indexed to body surface area, LAVmin LA minimum volume indexed to body surface area, LAEV LA emptying volume indexed to body surface area
Fig. 3
Fig. 3
Correlation between peak systolic left ventricular atrioventricular plane displacement (AVPD) and left atrial (LA) volumes in healthy controls (blue circles) and patients with pulmonary arterial hypertension (red filled circles; light red are idiopathic and dark red are associated to systemic sclerosis). LAVmax LA maximum volume indexed to body surface area, LAVmin LA minimum volume indexed to body surface area, LAEV LA emptying volume indexed to body surface area
Fig. 4
Fig. 4
Correlation between peak systolic left ventricular global longitudinal strain (GLS), and atrioventricular plane displacement (AVPD) in healthy controls (blue circles) and patients with pulmonary arterial hypertension (red filled circles; light red are idiopathic and dark red are associated to systemic sclerosis). R2 = 0.02 in healthy controls and R2 = 0.278 in patients
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M, Aboyans V, Vaz Carneiro A, Achenbach S, Agewall S, Allanore Y, Asteggiano R, Paolo Badano L, Albert Barberà J, Bouvaist H, Bueno H, Byrne RA, Carerj S, Castro G, Erol Ç, Falk V, Funck-Brentano C, Gorenflo M, Granton J, Iung B, Kiely DG, Kirchhof P, Kjellstrom B, Landmesser U, Lekakis J, Lionis C, Lip GY, Orfanos SE, Park MH, Piepoli MF, Ponikowski P, Revel MP, Rigau D, Rosenkranz S, Völler H, Luis Zamorano J. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT) Eur Heart J. 2016;37:67–119. doi: 10.1093/eurheartj/ehv317. - DOI - PubMed
    1. Rådegran G, Kjellström B, Ekmehag B, Larsen F, Rundqvist B, Blomquist SB, Gustafsson C, Hesselstrand R, Karlsson M, Kornhall B, Nisell M, Persson L, Ryftenius H, Selin M, Ullman B, Wall K, Wikström G, Willehadson M, Jansson K, Stefan Söderberg on behalf of SveFPH and SPAHR (2016) Characteristics and survival of adult Swedish PAH and CTEPH patients 2000–2014. Scand Cardiovasc J 50:243–250 - PubMed
    1. Kylhammar D, Kjellström B, Hjalmarsson C, Söderberg S, Wikström G, Nisell M, Jansson K, Rådegran G, on behalf of SveFPH and SPAHR (2018) A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension. Eur Heart J 39:4175–4181 - PubMed
    1. Van Wolferen SA, Marcus JT, Boonstra A, Marques KM, Bronzwaer JG, Spreeuwenberg MD. Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterialhypertension. Eur Heart J. 2007;28:1250–1257. doi: 10.1093/eurheartj/ehl477. - DOI - PubMed
    1. Foschi M, Di Mauro M, Tancredi F, Capparuccia C, Petroni R, Leonzio L, Romano S, Gallina S, Penco M, Cibelli M, Calafiore A. The dark side of the moon: the right ventricle. J Cardiovasc Dev Dis. 2017 doi: 10.3390/jcdd4040018. - DOI - PMC - PubMed

MeSH terms

Grants and funding

LinkOut - more resources