Right ventricular diastolic dysfunction in patients with left ventricular hypertrophy: analysis of right ventricular myocardial relaxation using two-dimensional speckle tracking imaging
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Although several previous studies have suggested the presence of right ventricular (RV) diastolic dysfunction in patients with hypertrophic cardiomyopathy (HCM) and those with hypertensive left ventricular hypertrophy (HT-LVH), the mechanisms are still unclear. This study aimed to clarify the relationship between the RV global diastolic dysfunction in these patients and the regional myocardial diastolic function, including synchronicity of the interventricular septum and RV free wall.
In 20 age-matched patients with HT-LVH, 20 patients with HCM and 22 control subjects without pulmonary hypertension, RV isovolumic relaxation time (IRTR) was measured using continuous-wave Doppler echocardiography. The early diastolic peak strain rate (E SR) and time from QRS to E SR (T–E SR) were measured in the apical, mid-ventricular and basal segments of the interventricular septum and RV free wall using two-dimensional speckle tracking imaging (2DST).
IRTR was more prolonged both in HT-LVH and in HCM than in the controls. The averaged septal E SR was reduced both in HT-LVH and in HCM (P < 0.0001, respectively), but the averaged RV free wall E SR was decreased only in HCM (P = 0.0007). E SR averaged for six septal and RV free wall segments was correlated with IRTR (r = −0.46, P = 0.0001). Neither intergroup difference nor correlation with IRTR was observed in a coefficient of variation of T–E SR for the six segments.
RV global diastolic function is impaired in patients with HT-LVH and HCM due to relaxation abnormalities, not an asynchrony, of the myocardium surrounding the RV cavity. The detection of RV free wall relaxation abnormality using 2DST may be useful to differentiate HCM from HT-LVH.
KeywordsRight ventricular diastolic function Left ventricular hypertrophy Hypertension Hypertrophic cardiomyopathy Two-dimensional speckle tracking imaging
- 8.Tops LF, Suffoletto MS, Bleeker GB, Boersma E, van der Wall EE, Gorcsan J 3rd, et al. Speckle-tracking radial strain reveals left ventricular dyssynchrony in patients with permanent right ventricular pacing. J Am Coll Cardiol. 2007;50:1180–8. doi: 10.1016/j.jacc.2007.06.011.PubMedCrossRefGoogle Scholar
- 13.Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography: American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2:358–67.PubMedGoogle Scholar
- 14.Takatsuji H, Mikami T, Urasawa K, Teranishi J, Onozuka H, Takagi C, et al. A new approach for evaluation of left ventricular diastolic function: spatial and temporal analysis of left ventricular filling flow propagation by color M-mode Doppler echocardiography. J Am Coll Cardiol. 1996;27:365–71. doi: 10.1016/0735-1097(96)81240-X.PubMedCrossRefGoogle Scholar
- 16.Kato TS, Noda A, Izawa H, Yamada A, Obata K, Nagata K, et al. Discrimination of nonobstructive hypertrophic cardiomyopathy from hypertensive left ventricular hypertrophy on the basis of strain rate imaging by tissue Doppler ultrasonography. Circulation. 2004;110:3808–14. doi: 10.1161/01.CIR.0000150334.69355.00.PubMedCrossRefGoogle Scholar
- 17.Goto K, Mikami T, Onozuka H, Kaga S, Inoue M, Komatsu H, et al. Role of left ventricular regional diastolic abnormalities for global diastolic dysfunction in patients with hypertrophic cardiomyopathy. J Am Soc Echocardiogr. 2006;19:857–64. doi: 10.1016/j.echo.2006.02.013.PubMedCrossRefGoogle Scholar
- 25.Lindqvist P, Waldenstrom A, Henein M, Morner S, Kazzam E. Regional and global right ventricular function in healthy individuals aged 20–90 years: a pulsed Doppler tissue imaging study: Umea General Population Heart Study. Echocardiography. 2005;22:305–14. doi: 10.1111/j.1540-8175.2005.04023.x.PubMedCrossRefGoogle Scholar
- 26.Van de Veire NR, De Backer J, Ascoop AK, Middernacht B, Velghe A, Sutter JD. Echocardiographically estimated left ventricular end-diastolic and right ventricular systolic pressure in normotensive healthy individuals. Int J Cardiovasc Imaging. 2006;22:633–41. doi: 10.1007/s10554-006-9082-y.PubMedCrossRefGoogle Scholar