Author + information
- Christopher Austin,
- Khadija Alassas,
- Ricardo Pagan,
- Malik Al-Omari,
- Preetham Kumar,
- Katherine Duello,
- Charles Burger and
- Brian Shapiro
Elevated mean right atrial pressure (RAP) measured by cardiac catheterization is an independent risk factor for mortality in the REVEAL (Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management) registry. This study was designed to assess the predictive value of RAP estimation by echocardiography in patients with idiopathic pulmonary arterial hypertension or associated pulmonary arterial hypertension.
Clinical and hemodynamic variables were assessed in 134 patients presenting at our institution with idiopathic or associated pulmonary arterial hypertension. The primary outcome measure was time to all-cause mortality from index presentation (data available in all). Echocardiographic estimation of RAP was inferred by inferior vena cava (IVC) diameter and collapsibility. Analysis of survival between groups as defined by RAP, IVC diameter and IVC collapsibility was calculated by Logrank test.
Overall median survival for estimated RAP ranging 6 to 10 mmHg, 10 to 15 mmHg and greater than 15 mmHg was 1874 days (95% CI, 1676-2071), 1527 days (95% CI, 494-2559) and 557 days (95% CI, 133-978) respectively. Mortality for estimated RAP ranging from 0 to 5 mmHg, 6 to 10 mmHg, 10 to 15 mmHg and greater than 15 mmHg was 17.9%, 37.5%, 45.7% and 46.4% respectively. Statistical significance of survival between RAP groups was demonstrated by Logrank test (Chi Square= 12.7, p=.005). Mortality was also predicted independently by IVC diameter (Chi Square = 11.2, p=0.0008) and IVC collapsibility (Chi Square=9.7, p=.008).
Elevated RAP as estimated by noninvasive echocardiography at baseline evaluation of both idiopathic and associated pulmonary arterial hypertension is predictive of decreased mean survival time. The results are consistent with the prognostic analysis from the REVEAL registry utilizing invasively measured RAP.
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: 1123-155
- 2013 American College of Cardiology Foundation