Contribution of ventricular diastolic dysfunction to pulmonary hypertension complicating chronic systolic heart failure

Wayne L. Miller, Douglas W. Mahoney, Hector I Michelena, Sorin V. Pislaru, Yan Topilsky, Maurice E Sarano

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objectives: The aim of the study is to clarify the clinical role of Doppler-echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) as determinants of pulmonary hypertension in patients experiencing left ventricular systolic dysfunction (LVSD) with and without the presence of functional mitral valve regurgitation (FMR). Background: Pulmonary hypertension (pulmonary venous or mixed pulmonary venous-arterial hypertension) complicating LVSD is associated with poor outcomes beyond that of LVSD alone. The view of the contribution of LVDD as a determinant of pulmonary hypertension is controversial and not well defined as a tool in clinical practice. Methods: Data from patients with LVEF ≤40% undergoing Doppler-echocardiography evaluations during the period from August 2001 to December 2004 were analyzed. Pulmonary systolic pressure (PSP), parameters of diastolic function (mitral valve [MV] transmitral flow velocity [E]/mitral annular diastolic velocity [e′] ratio, MV deceleration time [DT]), quantitated effective regurgitant orifice area (EROA) of FMR, and clinical characteristics were evaluated. Pulmonary hypertension was defined as an estimated PSP <45 mm Hg. Results: Criteria were met in 1,541 patients; one-third (n = 533) demonstrating PSP <45 mm Hg (58 ± 10 mm Hg, range 45 to 102 mm Hg). Patients with pulmonary hypertension were older with higher E/e′ ratio, EROA, and lower DT and LVEF. In multivariate analysis, pulmonary hypertension was independently predicted not only by severity of FMR (EROA <20 mm 2, odds ratio: 3.8, p < 0.001) but also by parameters of LVDD (E/e′ ratio <15, odds ratio: 3.31, p < 0.001; DT ≤150 ms, odds ratio: 3.8, p < 0.001). Receiver-operating characteristics curve analysis showed that EROA, E/e′ ratio, and DT provided significant incremental value in predicting pulmonary hypertension (c-statistic 0.830, p < 0.001). Conclusions: Patients with LVSD commonly have secondary pulmonary hypertension, which is largely determined by the severity of LVDD even with adjustment for FMR and low LVEF. Thus, measures of LVDD in routine clinical practice where PSP may not be estimated are important physiologic descriptors of hemodynamic status and are cumulatively linked in the prediction of pulmonary hypertension.

Original languageEnglish (US)
Pages (from-to)946-954
Number of pages9
JournalJACC: Cardiovascular Imaging
Volume4
Issue number9
DOIs
StatePublished - Sep 2011

Fingerprint

Systolic Heart Failure
Ventricular Dysfunction
Left Ventricular Dysfunction
Pulmonary Hypertension
Deceleration
Mitral Valve Insufficiency
Lung
Blood Pressure
Odds Ratio
Mitral Valve
Doppler Echocardiography
ROC Curve
Multivariate Analysis
Hemodynamics
Hypertension

Keywords

  • Doppler echocardiography
  • functional mitral valve regurgitation
  • heart failure
  • left ventricular diastolic dysfunction
  • secondary pulmonary hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Contribution of ventricular diastolic dysfunction to pulmonary hypertension complicating chronic systolic heart failure. / Miller, Wayne L.; Mahoney, Douglas W.; Michelena, Hector I; Pislaru, Sorin V.; Topilsky, Yan; Sarano, Maurice E.

In: JACC: Cardiovascular Imaging, Vol. 4, No. 9, 09.2011, p. 946-954.

Research output: Contribution to journalArticle

@article{94cd80eb7913470a8bf322a5779ddf98,
title = "Contribution of ventricular diastolic dysfunction to pulmonary hypertension complicating chronic systolic heart failure",
abstract = "Objectives: The aim of the study is to clarify the clinical role of Doppler-echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) as determinants of pulmonary hypertension in patients experiencing left ventricular systolic dysfunction (LVSD) with and without the presence of functional mitral valve regurgitation (FMR). Background: Pulmonary hypertension (pulmonary venous or mixed pulmonary venous-arterial hypertension) complicating LVSD is associated with poor outcomes beyond that of LVSD alone. The view of the contribution of LVDD as a determinant of pulmonary hypertension is controversial and not well defined as a tool in clinical practice. Methods: Data from patients with LVEF ≤40{\%} undergoing Doppler-echocardiography evaluations during the period from August 2001 to December 2004 were analyzed. Pulmonary systolic pressure (PSP), parameters of diastolic function (mitral valve [MV] transmitral flow velocity [E]/mitral annular diastolic velocity [e′] ratio, MV deceleration time [DT]), quantitated effective regurgitant orifice area (EROA) of FMR, and clinical characteristics were evaluated. Pulmonary hypertension was defined as an estimated PSP <45 mm Hg. Results: Criteria were met in 1,541 patients; one-third (n = 533) demonstrating PSP <45 mm Hg (58 ± 10 mm Hg, range 45 to 102 mm Hg). Patients with pulmonary hypertension were older with higher E/e′ ratio, EROA, and lower DT and LVEF. In multivariate analysis, pulmonary hypertension was independently predicted not only by severity of FMR (EROA <20 mm 2, odds ratio: 3.8, p < 0.001) but also by parameters of LVDD (E/e′ ratio <15, odds ratio: 3.31, p < 0.001; DT ≤150 ms, odds ratio: 3.8, p < 0.001). Receiver-operating characteristics curve analysis showed that EROA, E/e′ ratio, and DT provided significant incremental value in predicting pulmonary hypertension (c-statistic 0.830, p < 0.001). Conclusions: Patients with LVSD commonly have secondary pulmonary hypertension, which is largely determined by the severity of LVDD even with adjustment for FMR and low LVEF. Thus, measures of LVDD in routine clinical practice where PSP may not be estimated are important physiologic descriptors of hemodynamic status and are cumulatively linked in the prediction of pulmonary hypertension.",
keywords = "Doppler echocardiography, functional mitral valve regurgitation, heart failure, left ventricular diastolic dysfunction, secondary pulmonary hypertension",
author = "Miller, {Wayne L.} and Mahoney, {Douglas W.} and Michelena, {Hector I} and Pislaru, {Sorin V.} and Yan Topilsky and Sarano, {Maurice E}",
year = "2011",
month = "9",
doi = "10.1016/j.jcmg.2011.06.017",
language = "English (US)",
volume = "4",
pages = "946--954",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",
number = "9",

}

TY - JOUR

T1 - Contribution of ventricular diastolic dysfunction to pulmonary hypertension complicating chronic systolic heart failure

AU - Miller, Wayne L.

AU - Mahoney, Douglas W.

AU - Michelena, Hector I

AU - Pislaru, Sorin V.

AU - Topilsky, Yan

AU - Sarano, Maurice E

PY - 2011/9

Y1 - 2011/9

N2 - Objectives: The aim of the study is to clarify the clinical role of Doppler-echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) as determinants of pulmonary hypertension in patients experiencing left ventricular systolic dysfunction (LVSD) with and without the presence of functional mitral valve regurgitation (FMR). Background: Pulmonary hypertension (pulmonary venous or mixed pulmonary venous-arterial hypertension) complicating LVSD is associated with poor outcomes beyond that of LVSD alone. The view of the contribution of LVDD as a determinant of pulmonary hypertension is controversial and not well defined as a tool in clinical practice. Methods: Data from patients with LVEF ≤40% undergoing Doppler-echocardiography evaluations during the period from August 2001 to December 2004 were analyzed. Pulmonary systolic pressure (PSP), parameters of diastolic function (mitral valve [MV] transmitral flow velocity [E]/mitral annular diastolic velocity [e′] ratio, MV deceleration time [DT]), quantitated effective regurgitant orifice area (EROA) of FMR, and clinical characteristics were evaluated. Pulmonary hypertension was defined as an estimated PSP <45 mm Hg. Results: Criteria were met in 1,541 patients; one-third (n = 533) demonstrating PSP <45 mm Hg (58 ± 10 mm Hg, range 45 to 102 mm Hg). Patients with pulmonary hypertension were older with higher E/e′ ratio, EROA, and lower DT and LVEF. In multivariate analysis, pulmonary hypertension was independently predicted not only by severity of FMR (EROA <20 mm 2, odds ratio: 3.8, p < 0.001) but also by parameters of LVDD (E/e′ ratio <15, odds ratio: 3.31, p < 0.001; DT ≤150 ms, odds ratio: 3.8, p < 0.001). Receiver-operating characteristics curve analysis showed that EROA, E/e′ ratio, and DT provided significant incremental value in predicting pulmonary hypertension (c-statistic 0.830, p < 0.001). Conclusions: Patients with LVSD commonly have secondary pulmonary hypertension, which is largely determined by the severity of LVDD even with adjustment for FMR and low LVEF. Thus, measures of LVDD in routine clinical practice where PSP may not be estimated are important physiologic descriptors of hemodynamic status and are cumulatively linked in the prediction of pulmonary hypertension.

AB - Objectives: The aim of the study is to clarify the clinical role of Doppler-echocardiographic parameters of left ventricular diastolic dysfunction (LVDD) as determinants of pulmonary hypertension in patients experiencing left ventricular systolic dysfunction (LVSD) with and without the presence of functional mitral valve regurgitation (FMR). Background: Pulmonary hypertension (pulmonary venous or mixed pulmonary venous-arterial hypertension) complicating LVSD is associated with poor outcomes beyond that of LVSD alone. The view of the contribution of LVDD as a determinant of pulmonary hypertension is controversial and not well defined as a tool in clinical practice. Methods: Data from patients with LVEF ≤40% undergoing Doppler-echocardiography evaluations during the period from August 2001 to December 2004 were analyzed. Pulmonary systolic pressure (PSP), parameters of diastolic function (mitral valve [MV] transmitral flow velocity [E]/mitral annular diastolic velocity [e′] ratio, MV deceleration time [DT]), quantitated effective regurgitant orifice area (EROA) of FMR, and clinical characteristics were evaluated. Pulmonary hypertension was defined as an estimated PSP <45 mm Hg. Results: Criteria were met in 1,541 patients; one-third (n = 533) demonstrating PSP <45 mm Hg (58 ± 10 mm Hg, range 45 to 102 mm Hg). Patients with pulmonary hypertension were older with higher E/e′ ratio, EROA, and lower DT and LVEF. In multivariate analysis, pulmonary hypertension was independently predicted not only by severity of FMR (EROA <20 mm 2, odds ratio: 3.8, p < 0.001) but also by parameters of LVDD (E/e′ ratio <15, odds ratio: 3.31, p < 0.001; DT ≤150 ms, odds ratio: 3.8, p < 0.001). Receiver-operating characteristics curve analysis showed that EROA, E/e′ ratio, and DT provided significant incremental value in predicting pulmonary hypertension (c-statistic 0.830, p < 0.001). Conclusions: Patients with LVSD commonly have secondary pulmonary hypertension, which is largely determined by the severity of LVDD even with adjustment for FMR and low LVEF. Thus, measures of LVDD in routine clinical practice where PSP may not be estimated are important physiologic descriptors of hemodynamic status and are cumulatively linked in the prediction of pulmonary hypertension.

KW - Doppler echocardiography

KW - functional mitral valve regurgitation

KW - heart failure

KW - left ventricular diastolic dysfunction

KW - secondary pulmonary hypertension

UR - http://www.scopus.com/inward/record.url?scp=80052817278&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80052817278&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2011.06.017

DO - 10.1016/j.jcmg.2011.06.017

M3 - Article

VL - 4

SP - 946

EP - 954

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

IS - 9

ER -