MAT presumably results from right atrial hypertension and
distension, in turn resulting from pulmonary hypertension. At first
glance, the latter is simply the result of the pulmonary disease.
However, in the obstructive pulmonary disease population there is often
concomitant left ventricular disease, whether from coronary artery
disease, systemic hypertension, or aortic stenosis. Indeed, left
ventricular failure frequently accompanies the MAT,1–3
although hemodynamic and other functional data are largely lacking.
Hazard and Burnett,4half of whose patients had clinical
evidence of congestive heart failure, found the average pulmonary
capillary wedge pressure to be elevated (15.5 + 2.1 mm Hg). Further,
there is abnormal left ventricular filling in cor
pulmonale.5 Thus, elevated left ventricular diastolic and
pulmonary capillary pressure can contribute to the pulmonary
hypertension, ultimately expressed as MAT.