Echocardiographic Ventricular Septal Motion Abnormalities and no Left Atrial Enlargement are Associated with Pre-capillary Pulmonary Hypertension in Patients with Preserved Left Ventricular Function

Background: This study sought to evaluate the relationship between echocardiographic findings and the classification of pulmonary hypertension (PHTN). Ventricular septal motion abnormalities (VSMA) are common echocardiographic finding in patients with PHTN.

Methods: We retrospectively studied 146 consecutive patients with preserve left ventricular functions that were referred for right-heart catheterization for clinically suspected PHTN. VSMA was defined as any echocardiographic description of leftward abnormal septal motion or position.

Results: VSMA was present in 42 patients (29%). Patients with VSMA were younger and were more likely to have prior pulmonary embolism. They also had less obstructive sleep apnea, hypertension, and dyslipidemia. By echocardiography, patients with VSMA had lower left ventricular mass, left atrial size, and lateral wall E/e` ratio. At cardiac catheterization, PHTN was confirmed in all (100%) patients with VSMA (compared to 75% in patients without VSMA). 98% of patients with VSMA had elevated pulmonary vascular resistance (compared with 55% of the patients without VSMA; p

Conclusions: In patients with suspected PHTN, VSMA and lack of LAE are strongly associated with pre-capillary PHTN. Our findings suggest that patients with VSMA should be further evaluated by right-heart catheterization.