Antegrade Diastolic Pulmonary Artery Flow Implies Right Ventricular Restrictionin Adult Cases

Background: Premature opening of pulmonary valve and subsequent antegrade diastolic pulmonary artery flow (ADPAF) reflect restrictive right ventricular (RV) physiology in children. However, the study of ADPAF has been strangely neglected in adult cases. Purpose: To clarify the clinical implication of ADPAF in adult cases. Methods and Results: We studied 23049 consecutive adult patients who underwent echocardiography in our hospital from 2008 to 2015. ADPAF was found in 17 patients. Causative diseases included congenital heart diseases, cardiomyopathy, severe pulmonary valvular regurgitation, and pericardiac diseases. On cardiac catheterization, simultaneous recording of RV and PA pressures revealed the dip-and-plateau configuration of RV diastolic pressure which exceeded PA pressure during atrial systole. These data suggest that ADPAF reflects the inversion phenomenon between right ventricle and pulmonary artery pressures under the condition of right ventricular restrictive physiology. All patients were divided into two groups based on TAPSE. During a mean follow-up time of 692 days (range 15–2324), five patients died and one patient underwent implant of left ventricular assist system; overall mortality rate was 35.3%. Notably, patients with ADPAF and a TAPSE less than 16 mm had worse prognosis (P = .04). Conclusion: ADPAF could be a sign of right ventricular restriction in adult cases, and suggest a less favorable prognosis in patients with right ventricular dysfunction.