1. Risk classification of pulmonary arterial hypertension by echocardiographic combined assessment of pulmonary vascular resistance and right ventricular function.
- Author
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Kawamukai M, Hashimoto A, Koyama M, Nagano N, Nishida J, Mochizuki A, Kouzu H, Muranaka A, Kokubu N, Nagahara D, Yuda S, Tsuchihashi K, and Miura T
- Subjects
- Female, Follow-Up Studies, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Humans, Male, Middle Aged, Prognosis, Pulmonary Arterial Hypertension classification, Pulmonary Arterial Hypertension physiopathology, Pulmonary Artery diagnostic imaging, ROC Curve, Retrospective Studies, Risk Factors, Systole, Ventricular Function, Left physiology, Ventricular Function, Right physiology, Echocardiography methods, Pulmonary Arterial Hypertension epidemiology, Pulmonary Artery physiopathology, Pulmonary Wedge Pressure physiology, Risk Assessment, Vascular Resistance physiology
- Abstract
Which combination of clinical parameters improves the prediction of prognosis in patients with pulmonary arterial hypertension (PAH) remains unclear. We examined whether combined assessment of pulmonary vascular resistance and right ventricular function by echocardiography is useful for classifying risks in PAH. In 41 consecutive patients with PAH (mean age of 48.9 ± 17.3 years, 31 females), a 6-min walk test, pulmonary function test, and echocardiography were performed at baseline and during PAH-specific therapies. The study endpoint was defined as a composite of cardiovascular death and hospitalization for PAH and/or right ventricular failure. During a follow-up period of 9.2 ± 8.7 months, 18 patients reached the endpoint. Multivariate regression analysis showed that the ratio of tricuspid regurgitation pressure gradient to the time-velocity integral of the right ventricular outflow tract (TRPG/TVI) and tricuspid annular plane systolic excursion (TAPSE) during PAH-specific treatment were independent prognostic predictors of the endpoint. Using cutoff values indicated by receiver operating characteristic analysis, the patients were divided into four subsets. Multivariate analyses by Cox's proportional hazards model adjusted for age, sex and body mass index indicated that subset 4 (TRPG/TVI ≥ 3.89 and TAPSE ≤ 18.9 mm) had a significantly higher event risk than did subset 1 (TRPG/TVI < 3.89 and TAPSE > 18.9 mm): HR = 25.49, 95% CI 4.70-476.97, p < 0.0001. Combined assessment of TRPG/TVI and TAPSE during adequate PAH-specific therapies enables classification of risks for death and/or progressive right heart failure in PAH.
- Published
- 2019
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