Author + information
- Received April 4, 2018
- Revision received August 6, 2018
- Accepted August 9, 2018
- Published online November 4, 2019.
- Leah Wright, BSca,b,
- Nathan Dwyer, MBBS, PhDc,
- Sudhir Wahi, MBBS, MDd and
- Thomas H. Marwick, MBBS, PhD, MPHb,∗ ()
- aMenzies Institute for Medical Research, Hobart, Australia
- bBaker Heart and Diabetes Institute, Melbourne, Australia
- cRoyal Hobart Hospital, Hobart, Australia
- dPrincess Alexandra Hospital, Brisbane, Australia
- ↵∗Address for correspondence:
Prof. Thomas H. Marwick, Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, VIC 3004, Australia.
Objectives The aim of this study was to evaluate the relative value of baseline and follow-up echocardiographic assessment of pulmonary artery systolic pressure (PASP) and right ventricular (RV) function in assessing response to vasodilator therapy in pulmonary arterial hypertension (PAH).
Background Routine follow-up of PASP and RV function is widely obtained in patients undergoing treatment for PAH, but the value of this reassessment is uncertain.
Methods Of 162 prospectively recruited patients with PAH, 96 were included in this analysis of patients with ≥3 sequential echocardiographic studies. PASP and RV function (including right ventricular free wall strain [RVFWS]) were measured at baseline and on follow-up 2-dimensional echocardiography. Univariate and multivariate Cox regression with nested models was used to determine incremental and independent predictors of all-cause mortality.
Results Changes between visits were minimal for all parameters (RVFWS, p = 0.46; RV end diastolic area, p = 0.48; tricuspid annular plane systolic excursion, p = 0.32; PASP, p = 0.66; right atrial area, p = 0.39; and inferior vena cava, p = 0.25). Over 3 years of follow-up, 29 patients died. Baseline RVFWS was an independent predictor of outcome (hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.83 to 0.97; p = 0.007), incremental to PASP and other clinical covariates (C statistic = 0.74, p = 0.001). Those who died showed no differences in RVFWS (p = 0.50), PASP (p = 0.90), and tricuspid annular plane systolic excursion (p = 0.83) between visits. When baseline measures and follow-up time were accounted for, mean changes in RVFWS (HR: 0.78; 95% CI: 0.63 to 0.96; p = 0.002), right atrial area (HR: 1.20; 95% CI: 1.07 to 1.40; p = 0.003), and inferior vena cava (HR: 66.5; 95% CI: 8.5 to 520.5; p < 0.001) over follow-up were significant in predicting outcome.
Conclusions In PAH, baseline RV function (RVFWS) is a strong predictor of outcome, independent of PASP. Changes throughout therapy appear minimal, and only changes in RVFWS, inferior vena cava, size, and right atrial area were associated with outcome.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Allan Klein, MD, served as Guest Editor for this paper.
- Received April 4, 2018.
- Revision received August 6, 2018.
- Accepted August 9, 2018.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.