Abstract 11181: Interdependence in the Biventricle and Its Association With Long-Term Outcome in Patients With Pulmonary Hypertension
Background: The development of right ventricular (RV) dysfunction in pulmonary hypertension (PH) patients has been associated with poor outcomes, but the interdependence in the biventricle and its association with long-term outcome in PH patients remains uncertain.
Methods: Forty-eight PH patients were recruited. Peak global radial and circumferential systolic, early and late diastolic strain rates were obtained from mid-left ventricular (LV) short axis view, and peak global longitudinal systolic, early and late diastolic strain rate were obtained from 3 standard apical views using two-dimensional speckle-tracking. Each speckle-tracking parameter was expressed in absolute value. The optimal cutoff value to predict long-term outcome after adding PH-specific drugs was determined in 28 patients without taking PH-specific drugs at baseline, and then confirmed in all 48 patients. Long-term cardiovascular events were tracked over 2.8 years. Twenty EF-, age-, gender-matched normal volunteers were studied for comparison.
Results: Peak global early diastolic strain rate (Circ-ESR) in PH patients was significantly lower than that in normal subjects (1.28±0.60/s vs. 1.77±0.11/s, p=0.025). Kaplan-Meier curve indicated that PH patients with Circ-ESR>0.75/s experienced fewer cardiovascular events than those with Circ-ESR<0.75/s after adding PH-specific drugs (log-rank p=0.0001). An important finding of multivariate Cox proportional-hazards analysis revealed that Circ-ESR was the independent and powerful predictor of long-term cardiovascular events (hazard ratio=0.078, p=0.006) than other RV and LV functional parameters. Furthermore, Circ-ESR was associated with interventricular dyssynchrony, mitral inflow E and RV parameter of systolic function.
Conclusion: LV circumferential myocardial relaxation expressed in Circ-ESR has a potential to show the biventricular condition, and might be a key parameter for better management of PH patients.
- © 2013 by American Heart Association, Inc.