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Pulmonary Vascular Disease |

Diastolic Evaluation in Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction

Louis Lam*, MD; Balaji Tamarappoo, MD; Jennie Newman; Raed Dweik, MD; Adriano Tonelli, MD
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Cleveland Clinic, Cleveland, OH


Chest. 2012;142(4_MeetingAbstracts):805A. doi:10.1378/chest.1389757
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Abstract

SESSION TYPE: Pulmonary Hypertension I

PRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AM

PURPOSE: To assess the prevalence, severity and prognostic implications of diastolic dysfunction in pulmonary hypertension (PH) patients with elevated pulmonary artery occlusion pressure (PAOP) and preserved left ventricular ejection fraction (LVEF).

METHODS: We included patients with mean pulmonary artery pressure ≥ 25mmHg, PAOP > 15mmHg and LVEF > 50%, with diagnosis of PH group II (heart failure with preserved ejection fraction (HFpEF)). We excluded patients with valvular diseases, pericardial effusion, prosthetic valves or other cardiovascular surgeries. Two investigators reviewed the Doppler echocardiograms done within 3 months of the right heart catheterization.

RESULTS: Our cohort included 162 patients. The mean (SD) age was 63 (14) years and 56% were females. 85% of echocardiograms were performed within a month of the RHC. Diastolic function was graded (n=154) as normal (40%), grade I (35%), grade II (22%) and grade III (3%). PAOP did not vary among diastolic function groups. Median (IQR) left atrial volume was 26 (19-36) ml/m2 and it was directly related to the degree of diastolic function (p<0.001). Right ventricular outflow tract (RVOT) flow Doppler flow velocity envelope (n=118) showed no notch in 90% patients. Early notch was observed in only 1 patient. Median (95% CI) survival was 58 (42-74) months. Median survival was 43 months for grade I, 56 months for grade II, 43 months for grade III dysfunction (p=0.61). Mortality adjusted for age and gender was associated with tissue Doppler lateral peak a’ velocity (HR: 0.84 (95% CI: 0.74-0.97)) and septal peak a’velocity (HR: 0.85 (95% CI: 0.73-0.99)).

CONCLUSIONS: More than a third of patients with PH due to HFpEF have normal diastolic function by Doppler echocardiography. Tissue Doppler peak a' velocities were associated with survival.

CLINICAL IMPLICATIONS: Diastolic function grading by Doppler echocardiography is insensitive to identify patients with PH due to HFpEF. An early notch in the RVOT flow envelope is an extremely rare finding in patients with PH due to HFpEF.

DISCLOSURE: The following authors have nothing to disclose: Louis Lam, Balaji Tamarappoo, Jennie Newman, Raed Dweik, Adriano Tonelli

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Cleveland Clinic, Cleveland, OH

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