Pulmonary Vascular Disease |

Right Ventricular Fractional Area Change Is Predictive of Elevated Brain Natriuretic Peptide in Patients With Pulmonary Arterial Hypertension FREE TO VIEW

Arielle Fields; Howard Julien, MPH; Henry Siu; Michael Scharf; Praveen Mehrotra
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Thomas Jefferson University Hospital, Philadelphia, PA

Chest. 2014;146(4_MeetingAbstracts):840A. doi:10.1378/chest.1994823
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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: Pulmonary arterial hypertension (PAH) may lead to progressive right ventricular (RV) dysfunction, which portends adverse clinical outcomes. The routine evaluation of the RV in many echocardiography laboratories remains qualitative in nature. BNP levels can, however, provide more objective information regarding disease severity and patient prognosis. We sought, therefore, to determine the relationship between various quantitative echocardiographic right heart indices and elevated BNP levels.

METHODS: Sixty patients with known PAH and without evidence of concomitant left heart disease referred to our clinic were retrospectively identified. Echocardiograms at the time of initial clinic evaluation were analyzed. Biomarker data and clinical history were collected from patient records. Quantitative right heart parameters including RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), tricuspid annular velocity (TVS’) were assessed by echo. Patients were divided into those with or without elevated cardiac biomarkers (BNP or n-terminal pro-BNP). Receiver operating characteristic (ROC) analysis was used to compare the predictive ability of various echocardiographic parameters for elevated biomarkers.

RESULTS: TVS’ and and TAPSE were measured in 54 and 30 patients, respectively, while other parameters were available in all patients studied. Among patients with elevated biomarkers (n=38), the mean peak systolic pulmonary arterial pressure was significantly higher (73 vs. 49 mmHg, p<0.001). RVFAC was also significantly lower 27 vs. 38% (p<0.001) in these patients, while no difference was observed between TAPSE and TVS’ between the two groups. RA area was significantly higher in those with elevated biomarkers (24 vs. 18 cm2, p<0.001). By ROC analysis, RVFAC was most predictive of all echo parameters for elevated biomarkers in PAH patients with an area under the curve of 0.82 (95% CI: 0.70-0.93; p<0.001). An RVFAC of less than 35% provided a sensitivity and specificity of 74% and 76%, respectively; a value less than 30% provided a sensitivity and specificity of 62% and 86%, respectively.

CONCLUSIONS: Reduced RVFAC is predictive of elevated BNP levels in patients with PAH.

CLINICAL IMPLICATIONS: The quantitative assessment of RV function should be performed in the routine echocardiographic evaluation of patients with PAH.

DISCLOSURE: The following authors have nothing to disclose: Arielle Fields, Howard Julien, Henry Siu, Michael Scharf, Praveen Mehrotra

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