Abstract 13159: Adverse Right Ventricular Remodeling by Three Dimensional Echocardiographic Wall Motion Tracking in Pulmonary Hypertension is Associated with Patient Outcomes
Introduction: Right ventricular (RV) adaptive versus adverse remodeling is of prognostic significance in pulmonary hypertension (PH), but its assessment is difficult.
Objective: To apply the new technique of 3D echocardiographic wall motion tracking to quantify RV remodeling in PH patients and associate these findings with patient outcomes.
Methods: We studied 92 PH patients with 3D wall motion tracking (Toshiba Corp.) for RV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), RV ejection fraction (EF) and RV global area strain (G-AS). All PH patients had invasive systolic and mean pulmonary artery pressure (sPAP, mPAP), pulmonary vascular resistance (PVR), cardiac index (CI), and right atrial pressure (RAP) measured. We used receiver-operator characteristic (ROC) analysis with area under the curve (AUC) and regression of pressure-volume relations (sPAP and RV ESVI). We defined 3 PH groups: 1) RV Adapted, 2) RV Adapted-Remodeled and 3) RV Adverse-Remodeled. The primary end-point was hospitalization, death or lung transplantation over 6 months.
Results: RVESVI with a cut-off of 74 ml/m2 was significantly related to poor prognosis regarding death or lung transplantation (91% sensitivity, 68% specificity), with a significantly larger AUC compared to invasive RAP (0.84 vs. 0.70, p<0.01) and PVR (0.84 vs.0.66, p<0.01). Multivariate Cox regression analysis showed that RVESVI was independently related to death or transplantation. PH patients in the RV Adapted-Remodeled group with RVESVI 74-114ml/m2 had a moderately worse prognosis, and patients in the RV Adverse-Remodeled group with RVESVI > 114ml/m2 had the worst prognosis (p = 0.01).
Conclusion: 3D echocardiographic wall motion tracking RV volumes in PH patients coupled with invasive hemodynamics demonstrated morphological patient subsets of RV Adapted, RV Adapted-Remodeled and RV Adverse-Remodeled which were strongly related to the prognosis and has promise for clinical applications.
Author Disclosures: K. Ryo: None. A. Goda: None. A. Delgado-Montero: None. B. Tayal: None. M.A. Simon: None. M.A. Mathier: Research Grant; Modest; Actelion, Gilead, United Therapeutics. J. Gorcsan: Research Grant; Modest; Biotoronik, GE, TOSHIBA, Medtronic, St. Jude Medical.
- © 2014 by American Heart Association, Inc.