Author + information
- Julia Grapsa,
- Ines Zimbarra Cabrita,
- Giuliana Durighel,
- Benjamin Smith,
- David Dawson,
- Declan O'Regan,
- Wendy Gin-Sing,
- Luke SGE Howard,
- Simon JR Gibbs and
- Petros Nihoyannopoulos
The hypothesis of the study was whether any of the indices at the initial visit – prior to treatment initiation – could sufficiently predict clinical deterioration. Clinical deterioration was defined as death or admission to the hospital with signs of heart failure.
Thirty consecutive newly diagnosed patients (24 women, mean age 46.8 ± 5.3 years) with idiopathic pulmonary arterial hypertension (IPAH) were examined with two dimensional echocardiography (2DE), 3DE and CMR over a period of 24 months. The follow up of patients was performed every 6 months (4 follow up periods). Baseline right ventricular measurements took place before initiation of therapy. Therapy was initiated according to the established guidelines. All 30 patients were assessed for right ventricular volumes, ejection fraction and mass. In addition, 6 minute walk test distance, functional class and medical treatment were recorded in all the visits.
Within 2 years of follow up, mean right ventricular systolic pressure remained stable (initial study: 88 ± 21.3 mmHg vs. last study: 86.8 ± 22.2 mmHg, p=0.84) while there was significant increase of tricuspid annular diameter (initial study: 3.65 ± 0.67 cm vs. last study: 4.18 ± 0.27 cm, p<0.01). At the baseline study, 3 patients had severe tricuspid regurgitation (as per qualitative assessment). When all the indices were compared to clinical deterioration, the qualitative degree of tricuspid regurgitation was the strongest determinant for clinical deterioration (AUC: 0.908 when equal or worse than moderate). When volumetry and mass were associated with clinical deterioration, patients who clinically deteriorated had a more rapid increase of RV end-diastolic volume and end-systolic volumes when compared to stable patients. A right ventricular ejection fraction less than 23% together with regression of right ventricular mass indicated clinical deterioration.
A significant tricuspid regurgitation, a dilated right ventricle with impaired ejection fraction but regressed mass, may be significant determinant of clinical deterioration when found at the initial assessment of pulmonary arterial hypertensive patients.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Pulmonary Hypertension Imaging
Abstract Category: 27. Pulmonary Hypertension
Presentation Number: 1123-151
- 2013 American College of Cardiology Foundation