Increased contractility affects left ventricular kinetic energy in pulmonary hypertension

Precapillary pulmonary hypertension (PH) is characterized by increased pulmonary vascular resistance (PVR), with progressively altered right (RV) and left ventricular (LV) hemodynamics and function. Kinetic energy (KE) from 4D flow cardiovascular magnetic resonance (CMR) is a measure of intracardiac hemodynamics. In this observational case-control study, we investigate physiological mechanisms influencing RV-KE and LV-KE in PH. Twenty PH patients and 12 healthy controls underwent CMR including cine images and 4D flow. LV contractility was derived from noninvasive pressure-volume loops, and PVR from right heart catheterization. RV-KE and LV-KE were computed for systole, early and late diastolic filling, and indexed to stroke volume (SV). Systolic RV-KE did not differ between patients and controls. In patients, systolic RV-KE was associated with RV-SV but not with PVR, suggesting that the RV may still be able to compensate for the increased afterload. Systolic LV-KE indexed to LV-SV, LV contractility, and heart rate were all higher in patients than controls, suggesting sympathetic upregulation as a possible driving mechanism behind increased systolic LV-KE. LV contractility was negatively associated with systolic LV-KE and LV-SV. Late filling KE was increased in both ventricles in patients, suggesting an enhanced importance of the atrial kick to the filling of both ventricles.