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Pulmonary Vascular Disease |

Changes in Echo Measures With Therapy Predict Improved Outcome in Pulmonary Arterial Hypertension

Vasutakarn Chongthammakun, PhD; Kathryn Stackhouse; Richard Krasuski
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Cleveland Clinic Foundation, Cleveland, OH


Chest. 2014;146(4_MeetingAbstracts):841A. doi:10.1378/chest.1994316
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Abstract

SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters III

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Echocardiography is commonly utilized to follow patients with pulmonary arterial hypertension (PAH) following initiation of disease-specific therapy. Which changes in right heart measures best identify a favorable response to therapy, however, still remains unclear.

METHODS: We performed a nested case-control study derived from a 259 patient prospective, single-center cohort of incident pulmonary hypertension patients referred for initial hemodynamic evaluation. To provide uniformity, selection criteria included Dana Point diagnosis of Group I PAH, WHO function-class II or III, and survival for at least 1 year after therapy initiation (to ensure serial data collection). The index group consisted of 12 such patients who died during extended follow-up, and 24 age, gender, and WHO function-class matched controls who survived were further identified. Echos at baseline and after 1 year of therapy were interpreted in blinded fashion. Measures included right atrial (RA) diameters and area; inferior vena cava dimensions; right ventricular (RV) dimensions, thickness and contractility; diastolic/systolic RV flattening; eccentricity index; and tricuspid annular plane systolic excursion (TAPSE).

RESULTS: Age at presentation was 55±15 years, 29% were men, and WHO function class was II in 31% and III in 69%. 50% of patients were treated with phosphodiesterase-5 inhibitors, 25% with endothelin antagonists, 14% with IV prostanoids and 11% with combination therapy, with similar drug utilization in both groups. Median length of follow-up was 59 months. Survivors and decedents had similar baseline measures except for TAPSE, which was greater in survivors (1.6±0.5 vs. 1.2±0.4cm, p=0.011). Examining the 1 year changes, estimated RV systolic pressure decreased in survivors while increasing in decedents, (-8.9±13.6 vs. 7.3±8.4mmHg, p=0.001). Survivors had reductions in RA area, RA major axis diameter, and end-diastolic eccentricity index, while decedents had increases in all three (p=0.0302, 0.033 and 0.012 respectively). Fractional area change improved in survivors but did not change in decedents (7.0±8.5 vs. 0.8±7.0%, p=0.012).

CONCLUSIONS: Despite similar demographic features, functional class and therapies, some patients with PAH have adverse outcomes, with baseline TAPSE most predictive of this. Survivors have greater reductions in pulmonary pressure with volumetric improvements in RA and RV parameters.

CLINICAL IMPLICATIONS: Adverse changes in these parameters may signal a need for therapy escalation in these patients.

DISCLOSURE: The following authors have nothing to disclose: Vasutakarn Chongthammakun, Kathryn Stackhouse, Richard Krasuski

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