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RIGHT VENTRICULAR FRACTIONAL AREA CHANGE PREDICTS INVASIVELY-DETERMINED HEMODYNAMICS IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION
A1566 JACC March 17, 2015 Volume 65, Issue 10S
Pulmonary Hypertension and Venous Thrombo-embolic Disease Right Ventricular Fractional Area Change Predicts Invasively-Determined Hemodynamics in Patients with Pulmonary Arterial Hypertension Poster Contributions Poster Hall B1 Monday, March 16, 2015, 9:45 a.m.-10:30 a.m. Session Title: Noninvasive and Invasive Assessment of Pulmonary Hypertension Abstract Category: 24. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease Presentation Number: 1249-175 Authors: Howard M. Julien, Arielle Fields, Henry Siu, Michael Scharf, Praveen Mehrotra, Thomas Jefferson University Hospital, Philadelphia, PA, USA
Background: Evaluation of the right heart is critical in patients with pulmonary arterial hypertension (PAH). However, in many echocardiography laboratories this evaluation remains qualitative in nature. We sought to determine which quantitative right heart parameters by echocardiography were predictive of right heart pressures, pulmonary vascular resistance index (PVRI), and cardiac index (CI) in patients with PAH.
Methods: Fifty patients with known PAH and without evidence of concomitant left heart disease referred for right heart catheterization were retrospectively identified. Echocardiograms performed at the time of initial clinic visit were evaluated. Quantitative parameters of right heart function including right ventricular (RV) fractional area change (FAC) and RV outflow tract velocity-time integral (RVOT VTI) were assessed non-invasively by 2D and Doppler echocardiography. Abnormal RV FAC was defined as less than 35%. Right atrial (RA) area and basal RV end-diastolic diameter were also measured. Multivariable linear regression analysis was performed to determine the ability of right heart parameters to predict elevated RV systolic pressure (RVSP), PVRI, and CI.
Results: In univariate analysis, RV FAC was associated with invasively determined RVSP (r=-0.53, p<0.001), PVRI (r=-0.49, p<0.001), and CI (r=0.4, p=0.004). In patients with abnormal RVFAC, the mean RVSP (74±18 vs. 54±19 mmHg, p=0.001) and PVRI (984±483 vs. 562±323 dynes*sec*cm-5/m2, p=0.002) were significantly higher, while the mean CI (2.7±0.8 vs. 3.3±0.7 mL/m2, p=0.02) was significantly lower. The associations between RA area, RV size, RVOT VTI with invasively determined hemodynamics were weak. In multivariable linear regression analysis, RV FAC was the only right heart parameter that independently predicted invasively determined RV systolic pressure (β=-0.51, p=0.003), PVRI (β=-0.57, p=0.001), CI (β=0.39, p=0.035). Parameters of right heart size, tricuspid regurgitation severity and RVOT VTI were not significant. Conclusion: Reduced RVFAC independently predicts increased RVSP, increased PVRI, and reduced CI in PAH patients. RVFAC should be assessed in the routine evaluation of these patients.
Pulmonary Hypertension and Venous Thrombo-embolic Disease Right Ventricular Fractional Area Change Predicts Invasively-Determined Hemodynamics in Patients with Pulmonary Arterial Hypertension Poster Contributions Poster Hall B1 Monday, March 16, 2015, 9:45 a.m.-10:30 a.m. Session Title: Noninvasive and Invasive Assessment of Pulmonary Hypertension Abstract Category: 24. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease Presentation Number: 1249-175 Authors: Howard M. Julien, Arielle Fields, Henry Siu, Michael Scharf, Praveen Mehrotra, Thomas Jefferson University Hospital, Philadelphia, PA, USA
Background: Evaluation of the right heart is critical in patients with pulmonary arterial hypertension (PAH). However, in many echocardiography laboratories this evaluation remains qualitative in nature. We sought to determine which quantitative right heart parameters by echocardiography were predictive of right heart pressures, pulmonary vascular resistance index (PVRI), and cardiac index (CI) in patients with PAH.
Methods: Fifty patients with known PAH and without evidence of concomitant left heart disease referred for right heart catheterization were retrospectively identified. Echocardiograms performed at the time of initial clinic visit were evaluated. Quantitative parameters of right heart function including right ventricular (RV) fractional area change (FAC) and RV outflow tract velocity-time integral (RVOT VTI) were assessed non-invasively by 2D and Doppler echocardiography. Abnormal RV FAC was defined as less than 35%. Right atrial (RA) area and basal RV end-diastolic diameter were also measured. Multivariable linear regression analysis was performed to determine the ability of right heart parameters to predict elevated RV systolic pressure (RVSP), PVRI, and CI.
Results: In univariate analysis, RV FAC was associated with invasively determined RVSP (r=-0.53, p<0.001), PVRI (r=-0.49, p<0.001), and CI (r=0.4, p=0.004). In patients with abnormal RVFAC, the mean RVSP (74±18 vs. 54±19 mmHg, p=0.001) and PVRI (984±483 vs. 562±323 dynes*sec*cm-5/m2, p=0.002) were significantly higher, while the mean CI (2.7±0.8 vs. 3.3±0.7 mL/m2, p=0.02) was significantly lower. The associations between RA area, RV size, RVOT VTI with invasively determined hemodynamics were weak. In multivariable linear regression analysis, RV FAC was the only right heart parameter that independently predicted invasively determined RV systolic pressure (β=-0.51, p=0.003), PVRI (β=-0.57, p=0.001), CI (β=0.39, p=0.035). Parameters of right heart size, tricuspid regurgitation severity and RVOT VTI were not significant. Conclusion: Reduced RVFAC independently predicts increased RVSP, increased PVRI, and reduced CI in PAH patients. RVFAC should be assessed in the routine evaluation of these patients.