Right Ventricular Outflow Tract Doppler Notching Predicts Survival in Patients with Pulmonary Hypertension and Heart Failure with Preserved Ejection Fraction

Abstract

Background Pulmonary hypertension (PH) in the setting of left heart disease (PH-LHD) is the most common cause of PH in the general population, with a prevalence of up to 80% and is associated with high morbidity and mortality. We have previously demonstrated the utility of right ventricular outflow tract (RVOT) Doppler notching as a composite marker of pulmonary vascular disease (PVD) in patients with PH-associated with heart failure with preserved ejection fraction (HFpEF). Our study examines the ability of RVOT Doppler notching to predict survival in patients with PH-HFpEF. Methods We retrospectively evaluated consecutive patients referred to the Penn PH program between January 2007 and March 2013 diagnosed with PH-HFpEF. Patients were included who had right heart catheterization with mean pulmonary artery pressure ≥ 25mmHg and pulmonary artery wedge pressure > 15 mmHg. All patients underwent echocardiographic and hemodynamic assessment as indicated clinically. Statistical analysis included student's t-test and chi-squared to assess continuous and categorical variables, respectively, along with use of Cox regression and the Kaplan-Meier estimator to evaluate survival. Results Of 86 patients, 53 had notching and 33 did not. Baseline characteristics were similar across both groups. Patients with notching had higher diastolic pulmonary gradient (8.2±6.4 vs 1.4±4.3, p Conclusions In PH-HFpEF, RVOT Doppler notching is a composite marker of PVD and is a strong predictor of long-term survival. Further work is needed to validate this marker in larger cohorts.