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Clinical Worsening in Pulmonary Arterial Hypertension Is Predicted by Right Ventricular End-Systolic Area (RESA) and RV/LV Area Ratio During Recumbent Exercise Stress Echocardiography FREE TO VIEW

Geeta Godara; Dennis Atherton; Julie Hopkins; Mylan Cohen, MPH; Joel Wirth
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Pulmonary and Critical Care Medicine, Maine Medical Center, Portland, ME

Chest. 2014;146(4_MeetingAbstracts):863A. doi:10.1378/chest.1994383
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SESSION TITLE: Pulmonary Hypertension

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 28, 2014 at 02:45 PM - 04:15 PM

PURPOSE: Pulmonary Arterial Hypertension (PAH) clinical outcomes correlate with right ventricular (RV) functional reserve and exercise capacity. We sought to determine how RV/LV Area Ratio and RV End-Systolic Area (RVESA) obtained during rest and exercise performed as predictors of clinical worsening (CW) in PAH using recumbent exercise stress echocardiography (ESE).

METHODS: Subjects with WHO FC I-II PAH exercised by recumbent bicycle ergometer using an exercise protocol with 3-minute, 25 watt progressive increments. Echocardiographic parameters were acquired at rest and during peak exercise for later analysis. Testing was completed at a rate-pressure product (RPP) of 20,000 or stopped early for limiting symptoms. Each echocardiography parameter was measured by two independent observers and the average used for subsequent data analysis. Following the index ESE test, subjects were followed for evidence of CW (death, hospitalization for PAH, lung transplantation, or decline in 6MWD > 20%). Subjects were divided into CW and stable groups. Intergroup comparisons were considered statistically significantly different at p < 0.05. Test performance to predict CW was determined by receiver-operator characteristic (ROC) analysis. Interobserver agreement was assessed by Bland-Altman analysis.

RESULTS: Forty subjects with PAH (WHO FC I-II) were enrolled. During 48 months median follow up, 6/40 subjects developed CW. Baseline clinical and exercise measures were not statistically significant different between the groups. PAH-CW subjects had higher RV/LV Area Ratio during rest and exercise. PAH-CW subjects had higher RVESA during exercise. Resting echocardiography parameters did not predict PAH CW. Exercise RVESA and exercise RV/LV area ratio were both predictive of PAH clinical worsening (ROC AUC 0.71 and 0.76 respectively, both p < 0.05) and the curves were not statistically different from each other. The inter-observer agreement for data aquisition was better for exercise RVESA than RV/LV area ratio.

CONCLUSIONS: Clinical worsening due to PAH in WHO FC I-II patients was significantly associated with the exercise RVESA and the exercise RV/LV area ratio. Resting echocardiographic parameters were not predictive of PAH clinical worsening in this population. Exercise RVESA was more reproducible and performed similarly to exercise RV/LV area ratio in predicting PAH clinical worsening.

CLINICAL IMPLICATIONS: Echocardiography parameters obtained in PAH patients during recumbent ESE are reproducible and predictive of clinical worsening.

DISCLOSURE: The following authors have nothing to disclose: Geeta Godara, Dennis Atherton, Julie Hopkins, Mylan Cohen, Joel Wirth

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