Clinical Determinants and Prognostic Implications of Right Ventricular Dysfunction in Pulmonary Hypertension Caused by Chronic Lung Disease

Abstract

Background Patients with pulmonary hypertension caused by chronic lung disease (Group 3 PH ) have disproportionate right ventricle ( RV ) dysfunction, but the correlates and clinical implications of RV dysfunction in Group 3 PH are not well defined. Methods and Results We performed a cohort study of 147 Group 3 PH patients evaluated at the University of Minnesota. RV systolic function was quantified using right ventricular fractional area change ( RVFAC ) and + dP /dt max /instantaneous pressure. Tau and RV diastolic stiffness characterized RV diastolic function. Multivariate linear regression was used to define correlates of RVFAC . Kaplan‐Meier and Cox proportional hazards analyses were used to examine freedom from heart failure hospitalization and death. Positive correlates of RVFAC on univariate analysis were pulmonary arterial compliance, cardiac index, and left ventricular diastolic dimension. Conversely, male sex, N‐terminal pro‐brain natriuretic peptide, heart rate, right atrial enlargement, mean pulmonary arterial pressure, and pulmonary vascular resistance were negative correlates. Male sex was the strongest predictor of lower RVFAC , after adjusting for pulmonary vascular resistance and pulmonary arterial compliance. When comparing sexes, males had lower RVFAC (26% versus 31%, P =0.03) both overall and for any given mean pulmonary arterial pressure and pulmonary vascular resistance value. Males exhibited a reduction in + dP /dt max /instantaneous pressure as pulmonary vascular resistance increased, whereas females did not. There were no sex differences in RV diastolic function. RV dysfunction ( RVFAC <28%) was associated with increased risk of heart failure hospitalization or death (hazard ratio: 1.84, 95% CI : 1.04–3.10, P =0.035). Conclusions Male sex is associated with RV dysfunction in Group 3 PH , even after adjusting for RV afterload. RV dysfunction ( RVFAC <28%) identifies Group 3 PH patients at risk for poor outcomes.

Excess Protein O-GlcNAcylation Links Metabolic Derangements to Right Ventricular Dysfunction in Pulmonary Arterial Hypertension

“…RV contractility was estimated by calculating dp/dt max /instantaneous pressure from RV pressure tracings from right heart catheterization procedures using a custom-made program (LabView) as previously described [ 46 ].…”

Sex, Gender, and Sex Hormones in Pulmonary Hypertension and Right Ventricular Failure

“…Women have better RV systolic function in both health and PH, including Group 1 (PAH), Group 2 (left heart disease), and Group 3 (chronic lung disease/hypoxia) (192,196,269,323,444). The Multi-Ethnic Study of Atherosclerosis (MESA)-RV is the largest populationbased, cardiovascular disease-free cohort with available RV indices measured via cardiac magnetic resonance imaging (MRI), the gold standard for RV assessment.…”

“…When the cohort was limited to veterans with precapillary PH, women with PH were 29% more likely to survive. Women are also less likely to develop RV dysfunction in the setting of HFpEF (269) and exhibit better RV function in the setting of chronic lung disease (323). No gender bias in prevalence has been demonstrated in CTEPH (319).…”

Nomograms of Fetal Right Ventricular Fractional Area Change by 2D Echocardiography

“…Most cardiology studies have focused on the left ventricle (LV). However, recent evidence demonstrates that right ventricular (RV) dysfunction carries increased morbidity and mortality in different clinical conditions such as pulmonary arterial hypertension [1], acute myocardial infarction [2], and diverse congenital heart diseases (CHD) [3]. Moreover, RV function plays an important role in early neonatal hemodynamic adaptation to postnatal life, especially in preterm newborns and CHD [4,5].…”