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Original Research: PULMONARY VASCULAR DISEASE |

Regional Left Ventricular Systolic Function and the Right VentricleThe MESA Right Ventricle Study: The Multi-Ethnic Study of Atherosclerosis Right Ventricle Study

Christopher T. Dibble, MD; Joao A. C. Lima, MD; David A. Bluemke, MD, PhD; Julio A. Chirinos, MD; Harjit Chahal, MD; Michael R. Bristow, MD, PhD; Richard A. Kronmal, PhD; R. Graham Barr, MD, DrPH; Victor A. Ferrari, MD; Kathleen J. Propert, ScD; Steven M. Kawut, MD, FCCP
Author and Funding Information

From the Department of Medicine (Drs Dibble, Chirinos, Ferrari, and Kawut), Center for Clinical Epidemiology and Biostatistics (Drs Dibble, Propert, and Kawut), and Penn Cardiovascular Institute (Drs Chirinos, Ferrari, and Kawut), University of Pennsylvania School of Medicine Philadelphia, PA; Department of Medicine (Drs Lima and Chahal), Johns Hopkins School of Medicine, Baltimore, MD; Radiology and Imaging Sciences (Dr Bluemke), National Institutes of Health/Clinical Center, Bethesda, MD; Department of Medicine (Dr Bristow), Anschutz Medical Center, University of Colorado Denver, Aurora, CO; Collaborative Health Studies Coordinating Center (Dr Kronmal), Department of Biostatistics, University of Washington, Seattle, WA; and Department of Epidemiology (Dr Barr), Mailman School of Public Health, and Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.

Correspondence to: Steven M. Kawut, MD, FCCP, University of Pennsylvania School of Medicine, 718 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104; e-mail: kawut@mail.med.upenn.edu


Funding/Support: This work was supported by the National Institutes of Health [R01-HL066075, R01-HL086719, N01-HC95159 through HC95165, and T32-HL-007891].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):310-316. doi:10.1378/chest.10-1750
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Background:  Dysfunction of the interventricular septum has been implicated in right ventricular (RV) failure. However, little is known about the relationship between ventricular septal and RV function in patients without clinical cardiovascular disease. We hypothesized that better septal function would be associated with higher RV ejection fraction and lower RV mass and volume by cardiac MRI.

Methods:  In the Multi-Ethnic Study of Atherosclerosis (MESA), cardiac MRI was performed on community-based participants without clinical cardiovascular disease. Images were analyzed by the harmonic phase method to measure peak circumferential systolic midventricular strain for each wall (anterior, lateral, inferior, and septal). Multivariable linear regression and generalized additive models were used to assess the relationship between septal strain and RV morphology.

Results:  There were 917 participants (45.7% women) with a mean age of 65.7 years. Better septal function was associated with higher RV ejection fraction in a nonlinear fashion after adjustment for all covariates (P = .03). There appeared to be a threshold effect for the contribution of septal strain to RV systolic function, with an almost linear decrement in RV ejection fraction with septal strain from −18% to −10%. Septal function was not related to RV mass or volume.

Conclusions:  Interventricular septal function was linked to RV systolic function independent of other left ventricular regions, even in individuals without clinical cardiovascular disease. This finding confirms animal and human research suggesting the importance of septal function to the right ventricle and implies that changes in septal function could herald RV dysfunction.

Trial registry:  ClinicalTrials.gov; No.: NCT00005487; URL: www.clinicaltrials.gov

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