Clinical Investigation
Pulmonary Hypertension
Right Isovolumic Contraction Velocity Predicts Survival in Pulmonary Hypertension

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Background

Right ventricular function is a strong determinant of prognosis in severe pulmonary hypertension.

Methods

The aim of this study was to evaluate the prognostic value of estimates of right ventricular function obtained by echocardiography and Doppler tissue imaging and of functional class and 6-min walk distance (6MWD) in 142 patients with either pulmonary arterial hypertension (n = 104) or chronic thromboembolic pulmonary hypertension (n = 38). Echocardiography was prospectively performed, and demographics, medications, associated medical conditions, New York Heart Association class, and 6MWD at inclusion in addition to vital status, transplantation, and hospital admission related to pulmonary hypertension at follow-up were then collected by review of the medical records.

Results

Variables associated with overall survival by univariate analysis were 6MWD (P = .009), functional class (P = .024), tricuspid annular plane systolic excursion (P = .03) and isovolumic peak velocity at the tricuspid annulus (IVCv) (P = .003). On multivariate analysis, IVCv (P = .015) and 6MWD (P = .016) were the only independent predictors of survival. Kaplan-Meier estimates of survival at 1 year were 95% in patients with IVCv > 9 cm/sec and 80% in those with IVCv ≤ 9 cm/sec (P = .002). Intraobserver and interobserver variability of IVCv measurement were 5% and 9%, respectively.

Conclusions

Measurement of right ventricular function by Doppler tissue imaging, an easy, noninvasive, and reproducible method, is an independent predictor of clinical outcomes in patients with severe pulmonary hypertension.

Section snippets

Study Population

One hundred forty-two patients who underwent echocardiography for the evaluation of pulmonary hypertension were prospectively screened at two institutions: Louis Pradel University Hospital, Lyon, France (91 patients), and Erasme University Hospital, Brussels, Belgium (51 patients). The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's human research committee.

In all patients, a diagnosis of PAH or

Baseline Characteristics

Table 1 summarizes the demographic characteristics of the study population. Seventy-three percent of the patients had PAH, and 27% had CTEPH. The median delay between the diagnosis of pulmonary hypertension and inclusion with echocardiography and DTI was 1.4 years (range, 0–14 years). A majority of patients (n = 119) presented with established diagnoses of pulmonary hypertension (≥3 months), whereas in 23 patients, diagnoses were newly established (<3 months before the date of

Discussion

The present results demonstrate the prognostic value of RV function as assessed by IVCv in a large population of medically treated patients with pulmonary hypertension, including predominantly severe disease. Indeed, IVCv ≤ 9 cm/sec was the only independent predictor of mortality among RV function parameters on multivariate analysis and compared favorably with 6MWD, the prognostic significance of which is well validated. This observation is in agreement with our initial hypothesis of RV

Conclusions

Further studies are needed to refine practical recommendations for optimal noninvasive measurement of RV function and exploration of the biologic correlates of adaptation and cardiac failure.33 Because of the importance of clinical stability as a treatment goal in moderately severe PAH stressed in recent guidelines,20 it appears important to further assess echocardiography as a predictor of outcomes in patients with severe pulmonary hypertension. IVCv may be included in the routine

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    This study was supported by grant 3.4637.09 from Fonds National de la Recherche Scientifique Médicale (Brussels, Belgium).

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