Restrictive Right Ventricular Physiology: Its Presence and Symptomatic Contribution in Patients With Pulmonary Valvular Stenosis

ObjectivesThe aim of this study was to examine whether restrictive right ventricular (RV) physiology (the presence of antegrade pulmonary arterial flow in late diastole) occurred in patients with moderate to severe isolated pulmonary valvular stenosis (PVS) and to estimate its prevalence and relationship to RV function and patient symptoms.BackgroundLittle is published about RV diastolic performance in adult patients with PVS.MethodsA total of 43 consecutive patients (age 44 ± 10 years) with moderate to severe PVS referred to Royal Brompton Hospital from 2002 to 2005 were retrospectively studied. Patient New York Heart Association (NYHA) functional class was recorded. The RV (lateral tricuspid annulus motion) long-axis movement was measured by M-mode and pulsed-wave (PW) tissue Doppler imaging (TDI). Restrictive RV physiology was assessed by PW Doppler echocardiography.ResultsEighteen patients (42%) had restrictive RV physiology. They were more symptomatic (NYHA functional class 1.8 ± 0.5 vs. 1.3 ± 0.5; p < 0.001) and had poorer RV long-axis function (TDI peak systolic velocity 7.3 ± 2.1 cm/s vs. 9.7 ± 2.7 cm/s; TDI early diastolic velocity 6.6 ± 1.6 cm/s vs. 8.5 ± 2.4 cm/s; RV long-axis systolic amplitude 1.3 ± 0.2 cm vs. 1.5 ± 0.3 cm; p < 0.01 for all) compared with other PVS patients despite similar RV ejection fraction, myocardial performance index, and RV systolic pressure. The presence of restrictive RV physiology (odds ratio [OR] 6.05, 95% confidence interval [CI] 1.45 to 10.29; p = 0.01) and peak pulmonary valve pressure gradient (OR 1.07, 95% CI 1.01 to 1.13; p = 0.04) were the 2 independent echocardiographic predictors for decreased exercise tolerance in patients on multivariate analysis.ConclusionsRestrictive RV physiology is common in PVS patients. Its presence is related to a worse deterioration in RV long-axis function and decreased exercise tolerance in patients.