PURPOSE: Doppler-echocardiographic examination (DE) plays a central role in the diagnosis of pulmonary arterial hypertension (PAH). The role of the DE in the serial assessment of PAH is less well known. We sought to determine which 2-D and Doppler parameters are most influenced by PH specific therapy on serial DE examination.
METHODS: Clinical and echo-Doppler data were collected at incident PAH diagnosis (pre-therapy) and after a median 12 months on PH specific therapy. We compared measurements of right ventricular (RV) function such as tricuspid annular plane systolic excursion (TAPSE) and RV outflow tract velocity time integral (RVOT VTI), RV size, left ventricular (LV) size, and Doppler pulmonary artery systolic pressure (PASPDoppler). Data is presented as change between baseline and follow-up±SD; *P≤0.05, †P≤0.001.
RESULTS: In this cohort (n = 37), therapies included: 65% PDE5i and/or ERA, 35% prostacyclin, and 68% combination. The average six minute walk distance (6MWD) increased from 309 meters to 391 meters*, New York Heart Association (NYHA) functional class fell from 2.8 to 2.3*, and plasma brain natriuretic peptide (BNP) fell by 43%*. Serial DE exam revealed significant differences between incident diagnosis and median 12 month follow-up as follows: TAPSE +0.4±0.52 cm†; RVOT VTI +5.0±2.9 cm†; RV:LV dimension ratio -0.15±0.44*; LV dimensiondiastole +0.84±0.96 cm†; eccentricity indexsystole -0.40±0.75†. These changes reflect a significant improvement in RV size and function, and improved LV diastolic filling, likely due to less septal bowing into the LV. Despite these changes, PASPDoppler did not change (-3±36 mmHg, p=0.317).
CONCLUSIONS: In an incident PAH cohort showing significant clinical improvements on PH specific therapy, there were highly significant improvements in right and left heart structure and function as seen by DE exam involving relatively easy to measure parameters. These changes occurred in the absence of detectable changes in PASPDoppler.
CLINICAL IMPLICATIONS: The serial DE examination should focus on easily measured changes in RV and LV structure and function, and not changes in PASPDoppler, in response to PH specific therapy in PAH.
DISCLOSURE: The following authors have nothing to disclose: Anjali Fields, Justin Roberts, Paul Forfia
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