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Echocardiography. 2014 Jul;31(6):699-707. doi: 10.1111/echo.12468. Epub 2013 Dec 23.

Septal curvature is marker of hemodynamic, anatomical, and electromechanical ventricular interdependence in patients with pulmonary arterial hypertension.

Author information

1
Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California.

Abstract

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 (R(2) = 0.72, P < 0.001). Independent determinants of diastolic EI included relative RV area and mean PAP (R(2) = 0.69, P < 0.001). A systolic EI >1.08 differentiated patients with PAH from healthy controls with an AUC = 0.99. Patients with early systolic septal anterior motion (44% of subjects) had lower exercise capacity, more extensive ventricular remodeling, and worst ventricular function.

CONCLUSION:

Septal curvature is a useful marker of structural, hemodynamic, and electromechanical ventricular interdependence in PAH.

KEYWORDS:

heart failure; imaging; inter-ventricular dependence; pulmonary hypertension; septum

PMID:
24372843
DOI:
10.1111/echo.12468
[Indexed for MEDLINE]

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