Clinical InvestigationPulmonary HypertensionRight Isovolumic Contraction Velocity Predicts Survival in 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
References (39)
- et al.
Factors that prognosticate mortality in idiopathic pulmonary arterial hypertension: a systematic review of the literature
Respir Med
(2010) - et al.
Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy
J Am Coll Cardiol
(2011) - et al.
Frequency and prognostic significance of pericardial effusion in primary pulmonary hypertension
Am J Cardiol
(1999) - et al.
Right atrial size and tricuspid regurgitation severity predict mortality or transplantation in primary pulmonary hypertension
J Am Soc Echocardiogr
(2002) - et al.
Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension
J Am Coll Cardiol
(2002) - et al.
Value of a Doppler-derived index combining systolic and diastolic time intervals in predicting outcome in primary pulmonary hypertension
Am J Cardiol
(1998) - et al.
Prognostic relevance of the echocardiographic assessment of right ventricular function in patients with idiopathic pulmonary arterial hypertension
Int J Cardiol
(2010) - et al.
Right ventricular strain for prediction of survival in patients with pulmonary arterial hypertension
Chest
(2011) - et al.
Effects of the oral endothelin-receptor antagonist bosentan on echocardiographic and Doppler measures in patients with pulmonary arterial hypertension
J Am Coll Cardiol
(2003) - et al.
Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography
J Am Soc Echocardiogr
(2010)
Recommendations for the evaluation of left ventricular diastolic function by echocardiography
J Am Soc Echocardiogr
Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava
Am J Cardiol
Usefulness of isovolumic and systolic ejection signals by tissue Doppler for the assessment of left ventricular systolic function in ischemic or idiopathic dilated cardiomyopathy
Am J Cardiol
Tissue Doppler imaging evaluation of cardiac adaptation to severe pulmonary hypertension
Am J Cardiol
Prevalence and prognostic value of left ventricular diastolic dysfunction in idiopathic and heritable pulmonary hypertension
Chest
Long-term intravenous epoprostenol infusion in primary pulmonary hypertension: prognostic factors and survival
J Am Coll Cardiol
Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications: endorsed by the Japanese Society of Echocardiography
J Am Soc Echocardiogr
Validation study on the accuracy of echocardiographic measurements of right ventricular systolic function in pulmonary hypertension
J Am Soc Echocardiogr
Survival in patients with idiopathic, familial, and anorexigen-associated pulmonary arterial hypertension in the modern management era
Circulation
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This study was supported by grant 3.4637.09 from Fonds National de la Recherche Scientifique Médicale (Brussels, Belgium).