Pulmonary Vascular Disease |

Right Ventricular End-Diastolic Wall Stress Predicts Survival in Patients With Pulmonary Arterial Hypertension FREE TO VIEW

Karima Addetia, MD; Alex Zhai, MD; Aaron Leong, MD; Amal Bessissow, MD; Avi Shimony, MD; David Langleben, MD; Judith Therrien, MD
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University of Chicago, Chicago, IL

Chest. 2013;144(4_MeetingAbstracts):869A. doi:10.1378/chest.1703048
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SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Background: Accurate assessment of prognosis in patients with pulmonary hypertension (PH) is critical as it impacts decision-making as regards appropriate medical therapy, therapy escalation and referral for transplantation. The objective of this study was to determine whether survival in pulmonary arterial hypertension (PAH) patients is related to a surrogate measure of right ventricular end-diastolic wall stress (RVEDWS).

METHODS: Methods: Retrospective study of 46 consecutive adult patients (mean age 55±15 years, 75% female) with PAH (Table). Criteria for entry into the study included a diagnosis of PAH (documented mean pulmonary artery pressure mPAP ≥25mmHg at rest on right heart catheterization (RHC) and pulmonary artery wedge pressure <15mmHg) and continued follow-up in PH clinic until death or administrative censoring at the end of the study period. Patients were excluded if they did not have all the parameters required for calculation of RVEDWS. RVEDWS was calculated using data obtained at the time of diagnosis and based on Laplace law: r x p /λ, where r =basal right ventricular (RV) dimension at end-diastole in the apical 4-chamber view on echocardiography, p=RV end-diastolic pressure obtained from RHC data and λ=thickness of RV free wall at end-diastole in subcostal view. Kaplan-Meier survival curves and Cox proportional hazard models for high (≥25 g/cm2) vs. low (<25 g/cm2) RVEDWS were constructed.

RESULTS: Results: Average mPAP on RHC was 48±13mmHg. Over a mean follow-up duration of 4.0±2.3 years, 22/46 (48%) patients died. Mean RVEDWS for the population was 21±22g/cm2. Mean duration between echocardiography and cardiac catheterization was 2.9±4.1 months. RVEDWS ≥25 g/cm2 trended towards predicting survival in all 46 patients (hazard ratio (HR) 1.8; 95% CI, 0.7 to 4.6) and was a significant predictor in those patients (n=24) with cardiac index ≥2.0 L/min/m2 (HR 6.3; 95% CI 1.3 to 31.4).

CONCLUSIONS: Conclusions: Calculated RVEDWS measured at baseline clinical visit has prognostic value in patients with PAH and preserved cardiac output.

CLINICAL IMPLICATIONS: RVEDWS may provide clinicians with an additional prognostic tool in patients with PAH.

DISCLOSURE: The following authors have nothing to disclose: Karima Addetia, Alex Zhai, Aaron Leong, Amal Bessissow, Avi Shimony, David Langleben, Judith Therrien

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