Risk classification of pulmonary arterial hypertension by echocardiographic combined assessment of pulmonary vascular resistance and right ventricular function

• Published in: Heart and vessels 2019-11, Vol.34 (11), p.1789-1800
• Main Authors: Kawamukai, Mina, Hashimoto, Akiyoshi, Koyama, Masayuki, Nagano, Nobutaka, Nishida, Junichi, Mochizuki, Atsushi, Kouzu, Hidemichi, Muranaka, Atsuko, Kokubu, Nobuaki, Nagahara, Daigo, Yuda, Satoshi, Tsuchihashi, Kazufumi, Miura, Tetsuji
• Format: Article
• Language: English
• Subjects: Biomedical Engineering and Bioengineering; Body mass; Body mass index; Body size; Cardiac Surgery; Cardiology; Classification; Congestive heart failure; Echocardiography; Echocardiography - methods; Female; Females; Follow-Up Studies; Heart; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Hypertension; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Original Article; Patients; Prognosis; Pulmonary Arterial Hypertension - classification; Pulmonary Arterial Hypertension - epidemiology; Pulmonary Arterial Hypertension - physiopathology; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - physiopathology; Pulmonary functions; Pulmonary hypertension; Pulmonary Wedge Pressure - physiology; Regression analysis; Regurgitation; Respiratory function; Retrospective Studies; Right ventricular failure; Risk Assessment; Risk Factors; ROC Curve; Statistical models; Systole; Vascular Resistance - physiology; Vascular Surgery; Ventricle; Ventricular Function, Left - physiology; Ventricular Function, Right - physiology
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-019-01429-7

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  18.9 mm): HR = 25.49, 95% CI 4.70–476.97, p