PURPOSE: Pulmonary hypertension (PHTN) is a major risk factor for right ventricular (RV) failure and a marker of poor prognosis in patients with heart failure. While the determinants of PHTN in subjects with systolic dysfunction have been elucidated, the role of left ventricular hypertrophy (LVH) and diastolic dysfunction in the development of PHTN has not been adequately studied. The aim of our study was to determine a possible mechanism by which impaired diastolic function may contribute to the development of PHTN.
METHODS: Subjects with LVH, normal left ventricular systolic function and no significant valvular disease were enrolled in the study. PHTN was defined as pulmonary artery systolic pressure (PASP) >35 mm Hg. Frequency of Doppler signs of elevated left atrial (LA) pressure (pseudonormal and restrictive patterns of mitral inflow) was examined in patients with PHTN and in subjects with LVH and normal PASP, matched by age and gender.
RESULTS: The study population consisted of 188 subjects, 94 patients with pulmonary hypertension (36 men and 58 women, age 63±15 yrs) and 94 age and sex matched subjects with normal PASP. Subjects with PHTN had a significantly higher prevalence of Doppler signs of elevated LA pressure (23% vs. 7%, P=0.005, χ2 test).
CONCLUSION: Among patients with PHTN, subjects with elevated LA pressure had significantly higher PASP than subjects with normal LA pressure (59±14 mm Hg vs. 52±15 mm Hg, P=0.043, t-test).
CLINICAL IMPLICATIONS: Diastolic dysfunction may contribute to the development of Pulmonary hypertension by causing elevated left atrial pressure. Higher risk of developing PHTN and RV failure may account in part for the worse prognosis seen in patients with Doppler signs of elevated LA pressure. Further studies are needed to elucidate the role of diastolic dysfunction in the development of pulmonary hypertension.
DISCLOSURE: Naushad Shaik, None.