J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 4, April 2017, pages 353-359

Left Ventricular Diastolic Function Assessment of a Heterogeneous Cohort of Pulmonary Arterial Hypertension Patients

**Table 1.** Baseline Characteristics of Study Patients
Variables	LVDD 0 (n = 46)	LVDD 1 (n = 61)	LVDD 2 (n = 21)	P-value
SD: standard deviation; BSA: body surface area; PH: pulmonary hypertension; WHO: World Health Organization; LVDD: left ventricular diastolic dysfunction. ^†Bonferroni test indicates significant differences between LVDD 0 and LVDD 1 and ^¶LVDD 0 and LVDD 2.
Age (± SD), years	50 ± 14	63 ± 13	57 ± 14	< 0.001^†
Gender (%)
Female	37 (80%)	46 (75%)	17 (81%)	0.808
Male	9 (20%)	15 (25%)	4 (19%)
BSA (± SD), m²	1.98 (0.03)	2.01 (0.37)	2.21 (0.42)	0.034^¶
Co-morbidities (%)
Diabetes mellitus type 2	6 (13%)	13 (21%)	8 (38%)	0.07
Arterial hypertension	21 (46%)	35 (57%)	16 (76%)	0.06
Coronary artery disease	5 (11%)	13 (21%)	4 (19%)	0.39
Diagnosis of PH (%)
WHO group I	23 (50%)	25 (41%)	9 (42%)	0.173
WHO group II	8 (17%)	7 (11%)	5 (24%)
WHO group II	3 (7%)	8 (13%)	5 (24%)
WHO group IV	8 (17%)	9 (15%)	0 (0%)
WHO group V	1 (2%)	2 (3%)	0 (0%)
WHO groups I, III	3 (7%)	6 (10%)	0 (0%)
WHO groups II, III	0 (0%)	2 (3%)	0 (0%)
WHO groups I, II, III	0 (0%)	1 (2%)	2 (10%)
WHO groups II, III, IV	0 (0%)	1 (2%)	0 (0%)

Table 1. Baseline Characteristics of Study Patients

Variables

LVDD 0 (n = 46)

LVDD 1 (n = 61)

LVDD 2 (n = 21)

P-value

SD: standard deviation; BSA: body surface area; PH: pulmonary hypertension; WHO: World Health Organization; LVDD: left ventricular diastolic dysfunction. ^†Bonferroni test indicates significant differences between LVDD 0 and LVDD 1 and ^¶LVDD 0 and LVDD 2.

Age (± SD), years

50 ± 14

63 ± 13

57 ± 14

< 0.001^†

Gender (%)

Female

37 (80%)

46 (75%)

17 (81%)

0.808

Male

9 (20%)

15 (25%)

4 (19%)

BSA (± SD), m²

1.98 (0.03)

2.01 (0.37)

2.21 (0.42)

0.034^¶

Co-morbidities (%)

Diabetes mellitus type 2

6 (13%)

13 (21%)

8 (38%)

0.07

Arterial hypertension

21 (46%)

35 (57%)

16 (76%)

0.06

Coronary artery disease

5 (11%)

13 (21%)

4 (19%)

0.39

Diagnosis of PH (%)

WHO group I

23 (50%)

25 (41%)

9 (42%)

0.173

WHO group II

8 (17%)

7 (11%)

5 (24%)

WHO group II

3 (7%)

8 (13%)

5 (24%)

WHO group IV

8 (17%)

9 (15%)

0 (0%)

WHO group V

1 (2%)

2 (3%)

0 (0%)

WHO groups I, III

3 (7%)

6 (10%)

0 (0%)

WHO groups II, III

0 (0%)

2 (3%)

0 (0%)

WHO groups I, II, III

0 (0%)

1 (2%)

2 (10%)

WHO groups II, III, IV

0 (0%)

1 (2%)

0 (0%)

**Table 2.** Relevant Echocardiographic Data From the Studied Population (± SD)
Variables	LVDD 0 (n = 46)	LVDD 1 (n = 61)	LVDD 2 (n = 21)	P-value (ANOVA)
SD: standard deviation; LA: left atrium; LV: left ventricle; RV: right ventricle; PASP: pulmonary artery systolic pressure; LVEF: LV ejection fraction; TAPSE: tricuspid annular plane systolic excursion; RVFAC: RV fractional area change; TDI: tissue Doppler imaging; MV: mitral valve; MA: mitral annulus; LVDD: LV diastolic dysfunction. ^†Bonferroni test indicates significant differences between LVDD 0 and LVDD 1, ^¶LVDD 0 and LVDD 2, and ^§LVDD 1 and LVDD 2.
PASP (mm Hg)	46 ± 15	62 ± 23	55 ± 16	< 0.001^†
LVEF (%)	60 ± 9	60 ± 8	56 ± 9	0.106
LV end-systolic volume (cm³)	34.2 ± 16.5	28.8 ± 12.2	45.4 ± 21.5	< 0.001^{¶, §}
LV end-diastolic volume (cm³)	84.3 ± 28.5	71.6 ± 23.2	103.3 ± 45	< 0.001^{¶, §}
LA volume index (mL/m²)	241.6 ± 196.1	178.6 ± 138.1	238.9 ± 124.1	0.093
TAPSE (cm)	2.2 ± 0.5	2.0 ± 0.5	2.1 ± 0.6	0.037^†
RV end-systolic area (cm²)	19.7 ± 13.3	21.6 ± 13.9	22.4 ± 15.9	0.696
RV end-diastolic area (cm²)	40.8 ± 18.3	41.8 ± 23.2	41.1 ± 22.5	0.971
RVFAC (%)	54.1 ± 12.3	48.4 ± 12.3	46.8 ± 9.9	< 0.021^†
MV E velocity (cm/s)	88 ± 21	70 ± 19	123 ± 37	< 0.001^{†, ¶, §}
MV A velocity (cm/s)	59 ± 17	89 ± 21	96 ± 41	< 0.001^{†, ¶}
MV DT (ms)	196 ± 58	210 ± 59	200 ± 63	0.664
MV E/a ratio	1.6 ± 0.7	0.8 ± 0.2	1.4 ± 0.6	< 0.001^{†, §}
MA TDI E velocity (cm/s)	12 ± 3	8 ± 3	11 ± 3	0.083
MA TDI A velocity(cm/s)	9 ± 5	13 ± 10	9 ± 5	0.216
MA TDI E /A ratio	1.6 ± 0.9	0.9 ± 1.5	1.6 ± 0.9	0.016^†
MV E/MA TDI E ratio	10 ± 13	8 ± 3	17 ± 10	< 0.001^{¶, §}

Table 2. Relevant Echocardiographic Data From the Studied Population (± SD)

Variables

LVDD 0 (n = 46)

LVDD 1 (n = 61)

LVDD 2 (n = 21)

P-value (ANOVA)

SD: standard deviation; LA: left atrium; LV: left ventricle; RV: right ventricle; PASP: pulmonary artery systolic pressure; LVEF: LV ejection fraction; TAPSE: tricuspid annular plane systolic excursion; RVFAC: RV fractional area change; TDI: tissue Doppler imaging; MV: mitral valve; MA: mitral annulus; LVDD: LV diastolic dysfunction. ^†Bonferroni test indicates significant differences between LVDD 0 and LVDD 1, ^¶LVDD 0 and LVDD 2, and ^§LVDD 1 and LVDD 2.

PASP (mm Hg)

46 ± 15

62 ± 23

55 ± 16

< 0.001^†

LVEF (%)

60 ± 9

60 ± 8

56 ± 9

0.106

LV end-systolic volume (cm³)

34.2 ± 16.5

28.8 ± 12.2

45.4 ± 21.5

< 0.001^{¶, §}

LV end-diastolic volume (cm³)

84.3 ± 28.5

71.6 ± 23.2

103.3 ± 45

< 0.001^{¶, §}

LA volume index (mL/m²)

241.6 ± 196.1

178.6 ± 138.1

238.9 ± 124.1

0.093

TAPSE (cm)

2.2 ± 0.5

2.0 ± 0.5

2.1 ± 0.6

0.037^†

RV end-systolic area (cm²)

19.7 ± 13.3

21.6 ± 13.9

22.4 ± 15.9

0.696

RV end-diastolic area (cm²)

40.8 ± 18.3

41.8 ± 23.2

41.1 ± 22.5

0.971

RVFAC (%)

54.1 ± 12.3

48.4 ± 12.3

46.8 ± 9.9

< 0.021^†

MV E velocity (cm/s)

88 ± 21

70 ± 19

123 ± 37

< 0.001^{†, ¶, §}

MV A velocity (cm/s)

59 ± 17

89 ± 21

96 ± 41

< 0.001^{†, ¶}

MV DT (ms)

196 ± 58

210 ± 59

200 ± 63

0.664

MV E/a ratio

1.6 ± 0.7

0.8 ± 0.2

1.4 ± 0.6

< 0.001^{†, §}

MA TDI E velocity (cm/s)

12 ± 3

8 ± 3

11 ± 3

0.083

MA TDI A velocity(cm/s)

9 ± 5

13 ± 10

9 ± 5

0.216

MA TDI E /A ratio

1.6 ± 0.9

0.9 ± 1.5

1.6 ± 0.9

0.016^†

MV E/MA TDI E ratio

10 ± 13

8 ± 3

17 ± 10

< 0.001^{¶, §}

**Table 3.** Stepwise Multiple Logistic Regression Analysis to Determine the Best Predictor of Abnormal LV Diastolic Function
Variables	OR	95% CI	z	P-value
BSA: body surface area; PH: pulmonary hypertension; PASP: pulmonary artery systolic pressure; TAPSE: tricuspid annular plane systolic excursion; RVFAC: right ventricular fractional area change.
Age	1.06	1.03 - 1.10	3.36	0.001
Gender	1.42	0.47 - 4.30	0.63	0.531
BSA	3.15	0.77 - 12.99	1.59	0.111
Arterial hypertension	1.13	0.44 - 2.89	0.26	0.795
Diabetes mellitus	1.17	0.35 - 3.90	0.26	0.796
Classification of PH	1.10	0.75 - 1.60	0.48	0.630
PASP	1.03	1.00 - 1.07	2.17	0.030
TAPSE	0.80	0.28 - 2.32	-0.41	0.684
RVFAC	0.97	0.94 - 1.01	-1.26	0.206

Table 3. Stepwise Multiple Logistic Regression Analysis to Determine the Best Predictor of Abnormal LV Diastolic Function

Variables

95% CI

P-value

BSA: body surface area; PH: pulmonary hypertension; PASP: pulmonary artery systolic pressure; TAPSE: tricuspid annular plane systolic excursion; RVFAC: right ventricular fractional area change.

Age

1.06

1.03 - 1.10

3.36

0.001

Gender

1.42

0.47 - 4.30

0.63

0.531

BSA

3.15

0.77 - 12.99

1.59

0.111

Arterial hypertension

1.13

0.44 - 2.89

0.26

0.795

Diabetes mellitus

1.17

0.35 - 3.90

0.26

0.796

Classification of PH

1.10

0.75 - 1.60

0.48

0.630

PASP

1.03

1.00 - 1.07

2.17

0.030

TAPSE

0.80

0.28 - 2.32

-0.41

0.684

RVFAC

0.97

0.94 - 1.01

-1.26

0.206