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Prolonged right ventricular post-systolic isovolumic period in pulmonary arterial hypertension: a reflection of diastolic dysfunction?
  1. Gert-Jan Mauritz1,
  2. J Tim Marcus2,
  3. Nico Westerhof1,3,
  4. Pieter E Postmus1,
  5. Anton Vonk-Noordegraaf1
  1. 1Department of Pulmonary Diseases, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
  2. 2Department of Physics and Medical Technology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
  3. 3Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Professor A Vonk Noordegraaf, Department of Pulmonology, VU University Medical Center, Boelelaan 1117, 1007 MB Amsterdam, The Netherlands; a.vonk{at}vumc.nl

Abstract

Background In pulmonary arterial hypertension (PAH) a prolonged time interval between pulmonary valve closure and tricuspid valve opening is found. This period is interpreted as prolonged right ventricular (RV) relaxation, and thus a reflection of diastolic dysfunction. This concept recently has been questioned, since it was shown that RV contraction continues after pulmonary valve closure causing a post-systolic contraction period.

Objectives To investigate in PAH whether the increased RV post-systolic isovolumic period is caused by either an additional post-systolic contraction period, or an increased relaxation period (diastolic dysfunction).

Methods 23 patients with PAH (mean pulmonary arterial pressure 54±12 mm Hg), and 18 healthy subjects were studied using cardiac MRI. In a RV two-chamber view, times of pulmonary valve closure (TPVC) and tricuspid valve opening (TTVO) were measured, defining the total post-systolic isovolumic period. Time to peak of RV free wall contraction (TpeakRV) was determined with myocardial tagging. Post-systolic contraction and relaxation periods were defined as the time intervals between TPVC and TpeakRV and between TpeakRV and TTVO, respectively. These periods were normalised to an RR interval.

Results The total post-systolic isovolumic period was longer in patients than in healthy subjects (0.15±0.04 vs 0.04±0.02, p<0.001), but the relaxation period was not different (0.06±0.02 vs 0.05±0.02, p=0.09). The post-systolic contraction period in patients was strongly related to the total post-systolic isovolumic period (y=0.98x–0.05; r=0.89, p<0.001), and was associated with disease severity.

Conclusion In PAH, the prolonged post-systolic isovolumic period is caused by an additional post-systolic contraction period, rather than by an increased relaxation period.

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Footnotes

  • Funding Anton Vonk-Noordegraaf was supported by Netherlands Organisation for Scientific Research (NWO)-VIDI.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the the institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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