Right Ventricular Function and Right-Heart Echocardiographic Response to Therapy Predict Long-term Outcome in Patients With Pulmonary Hypertension

Various parameters reflecting right heart size, right ventricular function and capacitance have been shown to be prognostically important in patients with pulmonary hypertension (PH). In the advanced disease, patients suffer from right heart failure, which is a main reason for an impaired prognosis. Right heart size has shown to be associated with right ventricular function and reserve and is correlated with prognosis in patients with PH. Right ventricular reserve, defined as the ability of the ventricle to adjust to exercise or pharmacologic stress, is expressed by various parameters, which may be determined invasively by right heart catheterization or by stress-Doppler-echocardiography as a noninvasive approach. As the term “right ventricular contractile reserve” may be misleading, “right ventricular output reserve” seems desirable as a preferred term of increase in cardiac output during exercise. Both right heart size and right ventricular reserve have been shown to be of prognostic importance and may therefore be useful for risk assessment in patients with pulmonary hypertension. In this article we aim to display different aspects of right heart size and right ventricular reserve and their prognostic role in PH.

Download Full-text

Efficacy of Right Ventricular Free-Wall Longitudinal Speckle-Tracking Strain for Predicting Long-Term Outcome in Patients With Pulmonary Hypertension

Circulation Journal ◽

10.1253/circj.cj-12-1083 ◽

2013 ◽

Vol 77 (3) ◽

pp. 756-763 ◽

Cited By ~ 70

Author(s):

Yoshiki Motoji ◽

Hidekazu Tanaka ◽

Yuko Fukuda ◽

Keiko Ryo ◽

Noriaki Emoto ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Right Ventricular ◽

Speckle Tracking ◽

Ventricular Free Wall ◽

Free Wall ◽

Right Ventricular Free Wall ◽

Term Outcome ◽

Long Term Outcome

Download Full-text

Abstract 12967: Efficacy of Combining Assessment of Right Ventricular Function and Right Atrial Remodeling as Prognostic Factor in Patients With Pulmonary Hypertension

Circulation ◽

10.1161/circ.130.suppl_2.12967 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Yuko Fukuda ◽

Hidekazu Tanaka ◽

Yoshiki Motoji ◽

Keiko Ryo ◽

Hiroki Matsuzoe ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Right Ventricular ◽

World Health ◽

Right Atrial ◽

Atrial Remodeling ◽

Term Outcome ◽

Long Term Outcome ◽

Longitudinal Strains ◽

Rv Function

Background: Since survival of patients with pulmonary hypertension (PH) is closely related to right ventricular (RV) function, assessment of RV function is important for patients with PH. Right atrial (RA) area and/or RA pressure have also been reported to serve as prognostic predictors for adverse outcomes for in PH patient. Accordingly, we tested the hypothesis that the addition of RA remodeling to RV function enhances the capability of the latter to predict long-term outcome for PH patients. Methods: We studied 82 PH patients, all of whom underwent echocardiography and right heart catheterization. RV function was calculated by averaging the three regional peak speckle-tracking longitudinal strains from RV free wall (RV-free). RA remodeling was assessed as the RA area traced planimetrically at end-systole. Pre-defined cutoffs for RV dysfunction and RA remodeling were RV-free≤19.4% and RA area of >18cm2, respectively. Long-term unfavorable outcome events were tracked for 2.0 years. Results: RA area correlated with mean RA pressure (r=0.62, p<0.001), as well as with tricuspid E/E’ (r=0.38, p=0.001). However, RA area with RV restrictive filling was significantly larger than with others (all p<0.05). Kaplan-Meier analysis revealed that patients with RV-free ≤19.4% had worse long-term outcomes than those with RV-free >19.4% (log-rank p=0.01), as did patients with RA area>18cm2 compared with those with RA area ≤18cm2 (log-rank p<0.05). For sequential Cox models, a model based on hemodynamic parameters of RV performance (χ2 =3.11) was improved by addition of brain natriuretic peptide, World Health Organization functional class (χ2 =9.24; p<0.05), and RV-free (χ2 =17.11; p=0.005), and further improved by addition of RA area (χ2 =21.36, p<0.05). Conclusions: The combined assessment of RV function and RA remodeling results in more accurate prediction of long-term outcome, and may well have clinical implications for better management of PH patients.

Download Full-text