Prognostic value of the echocardiographic right/left ventricular end-diastolic diameter ratio in patients with idiopathic pulmonary arterial hypertension

Background Previous studies have shown that an echocardiographic right/left ventricular end-diastolic diameter ratio(RV/LV ratio)≥0.9 is an independent predictor of poor prognosis in patients with acute pulmonary embolism. The prognostic value of the RV/LV ratio in patients with idiopathic pulmonary arterial hypertension(IPAH) is still unknown. Methods We retrospectively enrolled 95 consecutive patients with newly diagnosed IPAH and 16 of them were reevaluated by echocardiography at 3-12 months following targeted therapy.Follow-up data were obtained by telephone interviews and review of the patients’ records.Results The RV/LV ratio was in parallel with the severity of World Health Orgnization(WHO) functional class and mean right atrial pressure.The RV/LV ratio was positively correlated with total pulmonary resistance(P P P 2 saturation(P P = 0.001),weight and absence of targeted therapy were independent predictors of death.No significant changes in the RV/LV ratio before and after targeted therapy were observed. A baseline RV/LV ratio≥0.84 or a further increase in the RV/LV ratio during targeted therapy indicated a poor prognosis. Conclusions The RV/LV ratio helps to assess the severity of IPAH and serves as an independent predictor of prognosis in patients with IPAH.

Renal sympathetic denervation reduces left ventricular hypertrophy and improves cardiac function in patients with resistant hypertension

This study investigated the effect of catheter-based renal sympathetic denervation （RD） on left ventricular hypertrophy （LVH） and systolic and diastolic function in patients with resistant hypertension. LVH and diastolic dysfunction are associated with elevated sympathetic activity and increased morbidity and mortality. The effect of RD on LVH and LV function is unclear

EFFECT OF PERINDOPRIL AND METOPROLOL ON LEFT VENTRICULAR HYPERTROPHY AND PERFORMANCE IN ESSENTIAL HYPERTENSION

The effects of perindopril and metoprolol on left ventricular hypertrophy (LVH) and function were studied in 47 essential hypertensive patients with LVH. Previous antihypertensive drugs were discontinued for at least 2 weeks, after which patients were randomly divided into 2 groups. 25 subjects were treated with perindopril 4 to 8 mg once daily in the morning (Group A) and 22 subjects with metoprolol 25 to 62.5 mg twice daily (Group B). The subjects were evaluated before and after 4 and 8 weeks of treatment by use of echocardiography. Before treatment LV mass indexes (LVMI) of two groups were respectively 143.2 ± 21.3 g / m2 and 140.6 ± 23.7 g / m2 (P>0.05). In Group A, reduction of LVMI occurred after 4 weeks of treatment, and more pronounced after 8 weeks (from 143.2 ± 21.3 g / m2 to 126.6 ± 15.3 g / m2, P< 0.001), whereas reduction of LVMI occurred only after 8 weeks in Group B (from 140.6 ± 23.7 g / m2 to 133.4 ± 13.2 g / m2, P< 0.001). In addition, there was a significant (P<0.05) difference in LVMI between the two groups after 8 weeks. LV systolic function remained unchanged, whereas E / A increased significantly (P< 0.001) in two groups after 8 weeks. In conclusion, antihypertensive treatment with perindopril and metoprolol induced a significant regression of LVH associated with improvement in LV diastolic performance. Perindopril, compared with metoprolol, was more effective in reversing LVH.

Evaluation of the asynchronization and function of the left ventricle in patients with chronic pulmonary hypertension by velocity vector imaging

Background Pulmonary hypertension （PH） is a set of pathophysiological syndromes characterized by increased pulmonary artery pressure and pulmonary vascular resistance,resulting in increased right ventricular afterload.The left and right ventricles interact through hemodynamics.What impact will PH have on synchronization and function of the left ventricle （LV）？ The aim of this study was to evaluate the synchronization of the left ventricular wall motion and left ventricular function in patients with varying degrees of PH using velocity vector imaging （Wl） technology.Methods Sixty patients with chronic PH served as the experimental group,and 20 healthy volunteers served as the control group.According to the different degrees of pulmonary artery systolic pressure,the experimental group was divided into three groups：mild,moderate,and severe PH groups.The time to peak systolic longitudinal velocity （Tvl）,the peak systolic longitudinal velocity （Vsl）,the peak diastolic longitudinal velocity （Vel）,the peak systolic longitudinal strain （SI）,and strain rate （SRI） in 18 segments were measured in each group.Results TvI in the control group and each group with PH was reduced from basal to apical segment,and in control group Tvl in various segments of the same wall and in different walls showed no significant difference （P ＞0.05）.With increase in pulmonary artery pressure,Tvl values measured showed an increasing trend in groups with PH.In groups with PH,Vsl and Vel of each wall were reduced sequentially from basal to apical segments,showing gradient change; Vsl and Vel values measured showed a decreasing trend with increase in pulmonary artery pressure,in which the differences of Vel values measured in the control group and the mild PH group were statistically significant （P ＜0.01）,and the differences between other groups were statistically significant （P ＜0.01）.In groups with PH,SI and SRI in basal segment and the middle segment of each wall were decreased; the difference between groups was statistically significant （P ＜0.01）.Conclusions Asynchronization of the LV and decreased left ventricular function were present in patients with chronic PH;WI technology can accurately evaluate left ventricular function in patients with PH,and indicators such as Tvl,Vsl,and Vel are valuable.