Abnormal mitral flow patterns are associated with increased pulmonary artery systolic pressure in chronic respiratory disease

In the present investigation, 60 patients (37 male and 23 female) presentin g elevated pulmonary artery systolic pressure (PASP) with or without chroni c respiratory disease were submitted to Doppler echocardiography at mitral and tricuspid levels. The following echo-Doppler indices were evaluated: pe ak E wave velocity, peak A wave velocity, E/A ratio, E wave deceleration ti me, isovolumic relaxation time, PASP, end-diastolic right ventricular diame ter (RVEDD), and maximal right atrial area (RAA). Patients were classified into three groups: group 1, normal mitral flow pattern (n = 16); group 2, i mpaired relaxation pattern (it = 29); group 3, restrictive pattern (n = 15) . Respiratory patients were 41% in group 1 and 100% in both group 2 and 3. Concomitant LV diseases were apparent in 19% of group 1, 72% of group 2, an d in 93% of group 3. The results showed statistically higher PASP in group 1 (54 +/- 9 mm Hg) as compared to group 2 (44 +/- 9 mm Hg) and group 1 (32 +/- 9 mm Hg) (p < 0.01 between groups). A leftward displacement of the inte rventricular septum in diastole was evident in 6% of group 1, 24% of group 2, and in 27% of group 3. We conclude that in patients with chronic respira tory disease abnormal mitral flow patterns are more likely to descend from primary LV dysfunction rather than from distorted septal geometry due to ri ght ventricular overload; in these circumstances, the presence of primary L V diastolic disease may account for the exacerbation of hypoxic pulmonary h ypertension.