Background
Right heart function is a major determinant of clinical outcome in patients with elevated pulmonary artery pressure due to pulmonary venous hypertension (PVHT) and pulmonary arterial hypertension (PAH). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. Higher levels of serum ADMA have been found in patients with IPAH, systemic sclerosis and pulmonary thromboembolism. ADMA levels have been correlated with pulmonary vascular resistance and survival. In our study, we aimed to compare right heart function and asymmetric dimethylarginine (ADMA) levels between PVHT and PAH patients.
Material-Method
Patients with PAH (idiopathic, eisenmenger syndrome, connective tissue disease) were placed in group I, patients with PVHT due to mitral stenosis (mitral valve area ≤ 1.5 cm2, (without any additional valve or left heart disease) and systolic pulmonary artery pressure ≥ 40 mmHg (measured by transthoracic echocardiography) were placed in group II, and healthy control subjects were placed in group III. Transthoracic echocardiographic evaluations were performed according to the guidelines of the American Society of Echocardiography. Venous blood samples were collected and the ADMA concentrations were obtained with ELISA kits.
Material-Method
Patients with PAH (idiopathic, eisenmenger syndrome, connective tissue disease) were placed in group I, patients with PVHT due to mitral stenosis (mitral valve area ≤ 1.5 cm2, (without any additional valve or left heart disease) and systolic pulmonary artery pressure ≥ 40 mmHg (measured by transthoracic echocardiography) were placed in group II, and healthy control subjects were placed in group III. Transthoracic echocardiographic evaluations were performed according to the guidelines of the American Society of Echocardiography. Venous blood samples were collected and the ADMA concentrations were obtained with ELISA kits.
Results
Patients in group I and group II had higher ADMA levels than control subjects. RA area and dimensions, RV volumes, grade of tricuspid regurgitation, systolic PAP, RV wall thickness, RVOT diameters were significantly higher in group I patients than in group II patients. RVMPI was lower, while the RVFAC and TV systolic tissue doppler velocity were higher in group II patients than in group I patients. Group II patients with mitral stenosis were divided to subgroups a; with lower PVR and b; with higher PVR according to Abbas Formula. Group IIb patients had a higher PAP and MPI, increased RA dimensions, and lower TV systolic tissue doppler derived systolic wave velocity and lower TAPSE than group IIa patients.
Conclusion
This study demonstrated that PAH versus PVHT caused greater enlargement of the right heart dimensions and impaired right heart function. Patients with pulmonary venous hypertension, and a higher PVR due to mitral stenosis, had an impaired TAPSE, MPI and decreased TV systolic tissue doppler derived systolic wave velocity which demonstrated that a higher PVR in PVHT may cause an impaired right heart function.
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