Abstract 15519: Assessment of Right Ventricular Adaptability to Increased Load in Patients With Pulmonary Arterial Hypertension Can Optimize the Timing of their Listing to Transplantation
Background: Finding predictors of transplant (Tx) free survival and timely identification of those with the need for Tx due to severe pulmonary arterial hypertension (PAH) are becoming increasing challenges with prolongation in Tx waiting time. Right ventricle (RV) performance is highly load dependent and RV failure is the main cause of death in PAH. Assessment of RV adaptability to load has proved useful in pulmonary venous hypertension for decision making prior to ventricular assist insertion. Now we investigated its predictive value for Tx-free survival in severe PAH aiming to provide new tools which can improve the Tx listing procedures in PAH.
METHODS: All consecutive potential Tx candidates with PAH (except congenital heart diseases) who were clinically stable and free from RV failure at their first evaluation performed in 2006-2012 were selected for the study. At selection, patients underwent echocardiography including 2D strain imaging. Examinations were repeated at each follow-up. Collected data were tested for ability to predict RV stability and Tx-free patient survival.
RESULTS: Of 79 evaluated patients, 23 (29.1%) showed irreversible RV failure (14 died, 7 underwent Tx, 2 remained on Tx lists). Comparing data obtained from these 23 patients obtained at inclusion in the study with those obtained also initially from the other 56 remaining stable, we found no differences in RV size, RVEF and tricuspid annulus plane systolic excursion (TAPSE). During the study period there were also no differences in medical treatment between the 2 groups. However, patients with subsequent worsening had initially a lower RV “load adaptation index” (LAI) and afterload-corrected peak global systolic longitudinal strain rate, as well as higher RV systolic dyssynchrony (for all p< 0.01). At certain cut-off values these parameters showed high predictive values for both 1 and 3 year freedom from RV failure and 3 year Tx-free patient survival. LAI reduction appeared highly predictive for short term (< 1 year) RV decompensation.
CONCLUSION: Assessment of RV adaptability to the increased load in PAH patients referred for Tx allows the prediction of RV stability and Tx-free patients survival during a period of 1 to 3 years. This can enable a more optimal timing of patient listing for Tx.
- © 2013 by American Heart Association, Inc.