Abstract
BackgroundRight ventricular (RV) function is an independent predictor of clinical outcomes in patients with pulmonary arterial hypertension (PAH). However, it remains controversial which RV parameter should be measured as an appropriate index for the treatment of PAH. The aim of this study was to identify the most useful parameter that correlates with hemodynamics and predicts clinical outcomes in PAH.ResultsMost of the clinical and echocardiographic RV parameters were significantly correlated with pulmonary vascular resistance (PVR) as well as mean pulmonary arterial pressure (mPAP). Among these, three dimensional right ventricular ejection fraction (3DRVEF) showed the strongest hemodynamic correlation, followed by 6-minute walk distance. Receiver operating characteristic analysis of association with cardiac events including death, hospitalization, and intervention revealed a greater area under the curve for 3DRVEF than for mPAP (0.78 vs. 0.74). Kaplan-Meier analysis showed that patients with 3DRVEF less than 38% had significantly shorter event-free survival than those with greater than 38% (P = 0.0007). Finally, the Cox proportional hazards analysis revealed that 3DRVEF, but not mPAP, was an independent predictor of clinical events in PAH.Materials and MethodsEighty-six consecutive patients were enrolled in this study. RV hemodynamic parameters were measured by right heart catheterization (RHC). RV function was assessed using two-dimensional speckle-tracking echocardiography and three-dimensional transthoracic echocardiography (3DTTE) to evaluate RV free wall global strain (RVFS) and RVEF.ConclusionsRVEF measured by 3DTTE could be a useful parameter for noninvasively assessing RV hemodynamics and predicting the clinical outcomes in PAH patients.
Highlights
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by elevated pulmonary vascular resistance (PVR) and resulting in right ventricular (RV) failure and death [1]
Most of the clinical and echocardiographic Right ventricular (RV) parameters were significantly correlated with pulmonary vascular resistance (PVR) as well as mean pulmonary arterial pressure
RV ejection fraction (RVEF) measured by 3DTTE could be a useful parameter for noninvasively assessing RV hemodynamics and predicting the clinical outcomes in pulmonary arterial hypertension (PAH) patients
Summary
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by elevated pulmonary vascular resistance (PVR) and resulting in right ventricular (RV) failure and death [1]. Regarding the RV contractility, RV strain might reflect the regional wall contraction more accurately and precisely than RVEF, RV strain would be affected by RV afterload (severity of PAH). Excessive RV dyssynchrony could potentially reduce cardiac output or increase filling pressure [12] It remains controversial which of these RV parameters is the most useful to evaluate the mechanism of dysfunction and predict clinical outcomes in PAH. Right ventricular (RV) function is an independent predictor of clinical outcomes in patients with pulmonary arterial hypertension (PAH). It remains controversial which RV parameter should be measured as an appropriate index for the treatment of PAH.
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