Echocardiographic and Hemodynamic Predictors of Survival in Precapillary Pulmonary Hypertension

Abstract

Consecutive patients with precapillary PH referred to the National Pulmonary Hypertension Service at Hammersmith Hospital between Background-In this study, we looked at the prognostic value of echocardiographic and hemodynamic measures in a large cohort of patients with precapillary pulmonary hypertension before and after initiation of treatment. were independent predictors of mortality. High pulmonary vascular resistance and right atrial pressure by invasive hemodynamic measurements were independent predictors of mortality (HR, 1.084; 95% confidence interval, 1.041-1.130, and 1.079, respectively; 95% confidence interval, 1.049-1.111; P<0.001 for both), whereas patients with a higher cardiac index had better survival overall (HR, 0.384; 95% confidence interval, 0.307-0.481; P<0.001). Conclusions-Right ventricular dysfunction, moderate-severe tricuspid regurgitation, low cardiac index, and raised right atrial pressure were associated with poor survival for both pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertensive disease patients. The severity of tricuspid regurgitation, myocardial performance index, presence of pericardial effusion, pulmonary vascular resistance, cardiac index, and right atrial pressure may be used to stratify risk of death. (Circ Cardiovasc Imaging. 2015;8:e002107.

Echocardiographic Assessment of the Right Ventricle–State of the Art

“…Right ventricular index of myocardial performance has been found to be a prognostic marker in patients with pulmonary hypertension, both as a single measurement, as well as when evaluated serially [19]. It has been studied in right ventricular infarction, hypertrophic cardiomyopathy and congenital heart disease.…”

Pulmonary vascular resistance versus pulmonary artery pressure for predicting right ventricular remodeling and functional tricuspid regurgitation

“…Although they are closely interrelated, the association between them is not always linear, and it is not uncommon to find discordant degrees of PASP and RV remodeling/FTR in routine clinical practice. Additionally, in advanced stages of PH, PASP can paradoxically drop due to RV failure and cardiac output decrease, and, conversely, increased PASP may reflect high volume or hyperdynamic states rather than pulmonary vascular disease. In this regard and resembling aortic stenosis in which valve gradient alone is not sufficient to assess aortic stenosis severity, pulmonary pressure gradients are flow dependent and may not properly reflect the pulmonary vascular status.…”

Predicting pericardial effusions in end-stage renal disease: Does pulmonary hypertension play a role?

“…Pulmonary hypertension (PH) has been described as a possible cause of pericardial effusion, and it may represent a necessary condition for the development and maintenance of pericardial effusion [12][13][14]. However, this issue has not been addressed among patients with ESRD.…”