PT  - JOURNAL ARTICLE
AU  - Marielle van de Veerdonk
AU  - Tim Marcus
AU  - Harm-Jan Bogaard
AU  - Nico Westerhof
AU  - Anton Vonk-Noordegraaf
TI  - Improved right ventricular function after substantial afterload reduction in patients with pulmonary arterial hypertension
DP  - 2012 Sep 01
TA  - European Respiratory Journal
PG  - 3276
VI  - 40
IP  - Suppl 56
4099  - http://erj.ersjournals.com/content/40/Suppl_56/3276.short
4100  - http://erj.ersjournals.com/content/40/Suppl_56/3276.full
SO  - Eur Respir J2012 Sep 01; 40
AB  - IntroductionIn pulmonary arterial hypertension (PAH), increased load leads to right ventricular (RV) dysfunction. We showed that despite a modest reduction in pulmonary vascular resistance (PVR) after treatment, RV function can decrease resulting in poor prognosis1.AimsWe hypothesize that RV function can be sustained when therapies reduce RV load to a larger extent. We will compare RV load in PAH patients with improved/stable RV function to patients with decreased RV function during follow-up.Methods76 patients underwent right heart catheterization to measure mean pulmonary artery pressure (mPAP) and PVR and MRI to assess RV ejection fraction (RVEF) at baseline and after 1 year of therapy. During a subsequent follow-up of 47months, 17 patients died.ResultsAfter therapy, 61% of the patients showed an improved/stable RVEF and had a better prognosis than patients with decreased RVEF (p=0.01). Patients with improved/stable RVEF showed a larger reduction in load (ΔmPAP: -9±12mmHg; ΔPVR: -231±301dyne·s·cm-5) than patients with decreased RVEF (ΔmPAP: 3±10mmHg; ΔPVR: 20±313dyne·s·cm-5, both p<0.001). Cardiac output (CO) increased in case of improved/stable RVEF (0.9±2.1L/min) and declined in case of decreased RVEF (0.4±1.8L/min, p=0.01). No differences were observed in 6-min walk distance or NT-proBNP.ConclusionsPAH patients with sustained RV function showed a substantial load reduction after therapy and had a better prognosis than patients with decreased RV function. This might imply that preserved RV function and improved survival can be achieved if mPAP is substantially reduced, which requires a strong decrease in PVR.References1vd Veerdonk et al. JACC 2011.