Abstract 12967: Efficacy of Combining Assessment of Right Ventricular Function and Right Atrial Remodeling as Prognostic Factor in Patients With Pulmonary Hypertension

Abstract

Background: Since survival of patients with pulmonary hypertension (PH) is closely related to right ventricular (RV) function, assessment of RV function is important for patients with PH. Right atrial (RA) area and/or RA pressure have also been reported to serve as prognostic predictors for adverse outcomes for in PH patient. Accordingly, we tested the hypothesis that the addition of RA remodeling to RV function enhances the capability of the latter to predict long-term outcome for PH patients. Methods: We studied 82 PH patients, all of whom underwent echocardiography and right heart catheterization. RV function was calculated by averaging the three regional peak speckle-tracking longitudinal strains from RV free wall (RV-free). RA remodeling was assessed as the RA area traced planimetrically at end-systole. Pre-defined cutoffs for RV dysfunction and RA remodeling were RV-free≤19.4% and RA area of >18cm2, respectively. Long-term unfavorable outcome events were tracked for 2.0 years. Results: RA area correlated with mean RA pressure (r=0.62, p<0.001), as well as with tricuspid E/E’ (r=0.38, p=0.001). However, RA area with RV restrictive filling was significantly larger than with others (all p<0.05). Kaplan-Meier analysis revealed that patients with RV-free ≤19.4% had worse long-term outcomes than those with RV-free >19.4% (log-rank p=0.01), as did patients with RA area>18cm2 compared with those with RA area ≤18cm2 (log-rank p<0.05). For sequential Cox models, a model based on hemodynamic parameters of RV performance (χ2 =3.11) was improved by addition of brain natriuretic peptide, World Health Organization functional class (χ2 =9.24; p<0.05), and RV-free (χ2 =17.11; p=0.005), and further improved by addition of RA area (χ2 =21.36, p<0.05). Conclusions: The combined assessment of RV function and RA remodeling results in more accurate prediction of long-term outcome, and may well have clinical implications for better management of PH patients.