Risk classification of pulmonary arterial hypertension by echocardiographic combined assessment of pulmonary vascular resistance and right ventricular function.
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.
['Kawamukai|Mina|M|', 'Hashimoto|Akiyoshi|A|http://orcid.org/0000-0002-9485-8635', 'Koyama|Masayuki|M|', 'Nagano|Nobutaka|N|', 'Nishida|Junichi|J|', 'Mochizuki|Atsushi|A|', 'Kouzu|Hidemichi|H|', 'Muranaka|Atsuko|A|', 'Kokubu|Nobuaki|N|', 'Nagahara|Daigo|D|', 'Yuda|Satoshi|S|', 'Tsuchihashi|Kazufumi|K|', 'Miura|Tetsuji|T|']
D004452:Echocardiography D005260:Female D005500:Follow-Up Studies D006352:Heart Ventricles D006801:Humans D008297:Male D008875:Middle Aged D011379:Prognosis D000081029:Pulmonary Arterial Hypertension D011651:Pulmonary Artery D011669:Pulmonary Wedge Pressure D012372:ROC Curve D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013599:Systole D014655:Vascular Resistance D016277:Ventricular Function, Left D016278:Ventricular Function, Right
Pulmonary arterial hypertension Tricuspid regurgitation pressure gradient Tricuspid annular plane systolic excursion Time–velocity integral