Abstract 13861: Cardiac Predictors of Outcomes in Patients With Pulmonary Arterial Hypertension

Abstract

Introduction: Pulmonary arterial hypertension (PAH) has significant anatomical, functional, and hemodynamic effects on the right heart. Yet, the prognostic value of these changes remains unclear. Methods: From the Cleveland Clinic Pulmonary Hypertension Registry, we included patients diagnosed with PAH between 2007-2013 who had right heart cath (RHC), transthoracic echocardiography (TTE), and cardiac computed tomography (CCT) within six months of each other. Right-sided ventricular and valvular anatomy and function were thoroughly assessed with CCT and TTE, while hemodynamics were determined by RHC. The primary outcome was a composite of all-cause mortality and hospitalization for PAH. The mean follow-up was 45 (+/- 42.4) months. Results: A total of 88 patients were included (mean age 55, 79% female). Among CCT, TTE, and RHC variables, RV diastolic pressure was the sole predictor of the primary outcome on multivariable analysis (HR 2.43, p=0.001) (Figure 1). When considering each outcome separately, central venous pressure and RV diastolic pressure were both predictive of death (HR 2.27, p=0.045 and 2.18, p=0.03 respectively), whereas RV diastolic pressure and pulmonary arterial mean pressure were predictors of hospitalization (HR 2.18, p=0.038 and 2.19, p=0.035 respectively) (Table 1). Tricuspid annular anatomy by CCT, and tricuspid regurgitation and RV size and function by TTE were not significantly associated with clinical outcomes. Conclusions: Right heart hemodynamics predict clinical outcomes in patients with PAH, while anatomic and functional characteristics do not.