J Cardiovasc Imaging.  2018 Jun;26(2):85-92. 10.4250/jcvi.2018.26.e6.

E/E′ and D-shaped Left Ventricle Severity in Patients with Increased Pulmonary Artery Pressure

• Kim BS
• Heo R
• Shin J
• Lim YH
• Park JK

• KMID: 2415458
• DOI: http://doi.org/10.4250/jcvi.2018.26.e6

Abstract

BACKGROUND
D-shaped left ventricle (D-LV) is an interesting echocardiographic finding in pulmonary hypertension (PH) and is the result of structural distortion of the interventricular septum. The eccentricity index (EI) is a quantitative measure used to evaluate the severity of D-LV in patients with increased pulmonary artery pressure (PAP). However, D-LV and EIs have rarely been studied in terms of their association with hemodynamic factors.
METHODS
A total of 526 patients with a maximal tricuspid regurgitation velocity (VmaxTR) > 2.8 m/s on echocardiography identified between January 2012 and December 2017 were enrolled. After exclusion, a total of 289 patients were analyzed. The association between D-LV and hemodynamic factors were analyzed using logistic regression. Furthermore, factors that impacted the severity of the D-LV, as defined by EIs, were also analyzed using the multiple linear regression model.
RESULTS
In the multivariate logistic regression model, higher pulmonary artery pressure (PAP, p = 0.001), lower tricuspid annular plane systolic excursion (TAPSE, p = 0.048), and E/E"² (p = 0.017) were found to be significant risk factors for the presence of D-LV. Additional analysis with age and body mass index added to independent variables, PAP (p = 0.008), TAPSE (p = 0.028), and age (p < 0.001) were significant risk factors for the presence of D-LV. In patients with D-LV, only E/E"² was independently associated with EIs (R2 = 0.666, p < 0.001).
CONCLUSIONS
In patients with increased PAP, D-LV is associated with PAP, TAPSE, E/E"², and age. EIs are associated with left ventricular filling pressure, represented as E/E"².

Keyword

Pulmonary hypertension; D-shaped left ventricle; Eccentricity index; E/E′

MeSH Terms

Body Mass Index
Echocardiography
Heart Ventricles*
Hemodynamics
Humans
Hypertension, Pulmonary
Linear Models
Logistic Models
Pulmonary Artery*
Risk Factors
Tricuspid Valve Insufficiency

Figure

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  Figure 1 Relationship between the eccentricity index (EI) and E/E′ in patients with D-shaped left ventricle.

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