Author + information
- Bahri Akdeniz1,
- Ebru Özpelit1,
- Can Sevinç2,
- Melih Birlik2,
- Kıvanç S Metin2,
- Nezihi Barış1 and
- Ozhan Goldeli1
Echocardiography which is commonly used as a screening test for pulmonary hypertension may also give valuable prognostic information. Although some recommendations are exist in guidelines, previous studies have conflicting results in this issue. In this study we aimed to investigate the role of several echocardiographic parameters for determining mortality and morbidity in patients with pulmonary hypertension (PH).
We enrolled the patients diagnosed with pulmonary arterial hypertension (PAH) or chronic thromboembolic hypertension (CTEPH) that were followed up at PAH outpatient clinic in Dokuz Eylül University Hospital. Echocardiography was performed in all cases. Right ventricular diameter (RVd), pulmonary artery diameter, right atrium area index (RAAi), right ventricular fractional area change (RVFAC) tricuspid annular plane systolic excursion (TAPSE) was examined at 2D and M mod Echo, systolic pulmonary artery pressure (sPAP), and pulmonary outflow tract flow velocity (PVmax) were assesed at Doppler echo, right ventricular lateral wall systolic motion (RV lat Sm) and Rv tei index (RVtei) were examined at tissue Doppler as continuous variables. The presence of pericardial effusion and severe of tricuspid regurgitation (TR) were investigated as categorical variables. Death for any cause or hospitalization due to clinical worsening was determined as a primary endpoint.
A total of 72 patients (54 female, mean age: 52.7±18.7 years) included the study. Mean follow up duration was 20.53 months (3-90). The distribution of patients regarding PH type and functional class were as follows: 20 with IPAH, 24 with congenital heart disease, 10 with connective tissue disease and 14 with CTEPH; 24 with class I,II 34 with class III and 14 with class IV. Primary end point occurred at 34 patient (25 patients died, 9 patients was hospitalized). The presence of severe TR (OR: 2.85; p=0.03), TAPSE (p=0.001), RVTei (p= 0,047) RVFAC (p= 0.049), ve sPAB (0.04) was found significant predictors for determining end point at univariate analysis. Other parameters was not found significant; RV lat Sm (p=0.32), RV diameter (p=0.15) PA diameter (p=0.39) PV max (p=0.06) ve RAAi (p=0.169).The presence of pericardial effusion tend to be higher, but not significant (%62.5-%38.3 OR: 2,68 (0.97-7.40) p= 0.053). Cox regression analysis revealed 2 variables persisting the prediction of primary endpoint; TAPSE <16.85 (HR: 3.17 p=0.006) and RVTei >0.49 (HR=3.70; p= 0.02). on the other hand severe TR (p=0.79) and sPAB>87 (p=0.64) were not significantly predictor at regression analysis (Table 1).
This single center study revealed the importance of TAPSE and RVTei index as echocardiographic markers for predicting prognosis. Other parameters did not make an additional benefit in this issue.
|Variables||Hazard Ratio||%95 CI||P value|
|TAPSE < 16.85 mm||3.17||1.36-7.23||0.006|
|sPAP >87 mmHg||1.18||0.56-2.48||0.64|
|Severe TR||1.11||0.48- 2.6||0.79|