Abstract
AimsPatients with pre-capillary pulmonary hypertension (PH) show poor survival, often related to right ventricular (RV) dysfunction. In this study, we assessed the 5-year prognostic value of a novel echocardiographic measure that examines RV function through the temporal relation between RV strain (ϵ) and area (i.e. RV ϵ-area loop) for all-cause mortality in PH patients.Methods and resultsEchocardiographic assessments were performed in 143 PH patients (confirmed by right heart catheterization). Transthoracic echocardiography was utilized to assess RV ϵ-area loop. Using receiver operating characteristic curve-derived cut-off values, we stratified patients in low- vs. high-risk groups for all-cause mortality. Kaplan–Meier survival curves and uni-/multivariable cox-regression models were used to assess RV ϵ-area loop’s prognostic value (independent of established predictors: age, sex, N-terminal pro B-type natriuretic peptide, 6-min walking distance). During follow-up 45 (31%) patients died, who demonstrated lower systolic slope, peak ϵ, and late diastolic slope (all P < 0.05) at baseline. Univariate cox-regression analyses identified early systolic slope, systolic slope, peak ϵ, early diastolic uncoupling, and early/late diastolic slope to predict all-cause mortality (all P < 0.05), whilst peak ϵ possessed independent prognostic value (P < 0.05). High RV loop-score (i.e. based on number of abnormal characteristics) showed poorer survival compared to low RV loop-score (Kaplan–Meier: P < 0.01). RV loop-score improved risk stratification in high-risk patients when added to established predictors.ConclusionOur data demonstrate the potential for RV ϵ-area loops to independently predict all-cause mortality in patients with pre-capillary PH. The non-invasive nature and simplicity of measuring the RV ϵ-area loop, support the potential clinical relevance of (repeated) echocardiography assessment of PH patients.
Highlights
Pulmonary hypertension (PH) is a progressive pulmonary vascular disease, which is associated with a poor 5-year survival rate.[1]
The primary cause of death relates to deterioration of right ventricular (RV) function, caused by the inability of the right ventricle to overcome the increased afterload.[2]
Risks/complications and inability for repeated measurements, alternative non-invasive measures of RV function may be more suitable in PH
Summary
Pulmonary hypertension (PH) is a progressive pulmonary vascular disease, which is associated with a poor 5-year survival rate.[1] The primary cause of death relates to deterioration of right ventricular (RV) function, caused by the inability of the right ventricle to overcome the increased afterload.[2] Approximately 44% of all deaths in patients with PH is caused by RV failure or sudden death.[3] Despite the inherent connection between PH-related death and RV function, current risk assessment guidelines only includes cardiac index [derived by invasive right heart catheterization (RHC)] and right atrial (RA) area as variables of RV function.[4] Given the invasiveness of RHC, associated. RV longitudinal e (a relatively novel echocardiographic derived indices) possesses independent prognostic value for PH-related events and all-cause mortality[5] and has been shown to be a stronger predictor than tricuspid annular plane excursion (TAPSE)[6] in patients with pre-capillary PH
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