Does the Different Type of Pulmonary Hypertension Cause the Same Effect on Right Heart and Serum Asymmetrical Dimethylargınıne Levels in Female Patients?

Objective: Right heart function is a major determinant of clinical outcome in patients with elevated pulmonary artery pressure due to pulmonary venous hypertension (PVH) and pulmonary arterial hypertension (PAH). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. In our study, we aimed to evaluate if different type of pulmonary hypertension (PH) cause the same effect on right heart functions and serum asymmetric dimethylarginine (ADMA) levels in female patients.

Methods: Patients with PAH as group I and patients with PVHT due to mitral stenosis (mitral valve area ≤ 1.5 cm(2), without any additional valve or left heart disease and systolic pulmonary artery pressure ≥ 50 mmHg in transthoracic echocardiography) as group II and healthy control subjects as group III included to the study. Transthorasic echocardiographic evaluations for right heart functions were performed according to the guidelines of the American Society of Echocardiography. Venous blood samples were collected and the serum ADMA concentrations obtained with ELISA kits.

Results: Patients in group I and group II had higher ADMA levels than control subjects. RA area and dimensions, RV volumes, grade of tricuspid regurgitation, systolic pulmonary arterial pressure (PAP), RV wall thickness, the right ventricular outflow tract (RVOT) diameters were significantly higher in group I patients than in group II patients. Right ventricular myocardial performance index (RVMPI) was lower and right ventricular fractional and change (RVFAC), TV systolic tissue doppler velocity were higher in group II patients than in group I.

Conclusion: This study demonstrated that PAH versuspulmonary hypertension (PHT) caused increased right heart dimensions and impaired right heart functions.