Predictive Value of Right Ventricular Function for Transplant-Free Survival with Pulmonary Arterial Hypertension

Abstract

Purpose Timely recognition of the need for transplantation (Tx) due to pulmonary arterial hypertension (PAH) and finding predictors of Tx-free outcome are increasingly challenging with Tx waiting time prolongation. Right ventricular failure (RVF) is associated with worse prognosis in PAH, but the prognostic value of parameters for RV evaluation and the impact of RVF on Tx-free survival are barely known. We assessed the predictability of RVF in PAH and the predictive value of RV dysfunction for Tx-free survival. Methods and Materials All consecutive Tx candidates with PAH (except PAH due to congenital shunts) without RVF at their first evaluation (2006-2010) were included in the study. At selection, after exercise testing and NT-proBNP measurement, patients underwent echocardiography with tissue Doppler and strain imaging. Examinations were repeated at each follow-up. Collected data were tested for ability to predict time course of RV function and Tx-free patient survival. Results Of 64 studied patients, 22 developed RVF. The 5-year Tx-free survival with and without RV worsening was 89% and 30%, respectively (p Conclusions In PAH patients referred for Tx, RV ΔP/Δt and certain strain parameters can predict the time course of RV function and Tx-free survival. Our results suggest that these parameters can improve Tx listing decisions.