Abstract 13941: Combined Assessment of Right Ventricular Function and Reverse Remodeling as Prognostic Marker after Administration of Medical Treatment for Pulmonary Hypertension
Background: Right ventricular (RV) dysfunction plays an important role in disease progression and prognosis of patients with pulmonary hypertension (PH). However, the association of RV reverse remodeling with long-term outcomes remains unclear. Our objective was thus to test the hypothesis that mid-term RV reverse remodeling after adding PH-specific drugs was linked to long-term outcomes in patients with PH.
Methods: We studied 45 PH patients with resting mean pulmonary artery pressure (mPAP) of 35±10mmHg. PH patients with chronic thromboembolic pulmonary hypertension and left-sided heart failure including pulmonary capillary wedge pressure of >15mmHg were excluded. Echocardiography was performed at enrollment and mid-term of 5.7±4.1 months after adding PH-specific drugs. RV function was calculated by averaging the three regional peak speckle-tracking longitudinal strains from RV free-wall (RV-free). RV remodeling was assessed in terms of the RV area, which was traced planimetrically at the end-systole (RVESA) from RV-focused apical 4-chamber views. Mid-term RV reverse remodeling was defined as a relative decrease in RVESA of at least 15%. Long-term event-free survival was then tracked for 5 years.
Results: Patients with mid-term RV reverse remodeling experienced favorable long-term outcomes than those without mid-term RV reverse remodeling (log-rank p<0.01). The incremental benefit using sequential Cox models in the prediction of long-term outcomes showed that a model based on clinical variables including mPAP and pulmonary vascular resistance (PVR) was improved by addition of RV-free (p=0.03), and further improved by addition of the parameter of mid-term RV reverse-remodeling (p=0.01).
Conclusion: Mid-term RV reverse remodeling after adding PH-specific drugs was associated with long-term outcomes, and this combined approach may well have clinical implications for better management of PH patients.
Author Disclosures: H. Sano: None. H. Tanaka: None. Y. Motoji: None. Y. Fukuda: None. K. Dokuni: None. Y. Hatani: None. K. Hatazawa: None. H. Matsuzoe: None. H. Toki: None. H. Shimoura: None. J. Ooka: None. T. Sawa: None. Y. Mochizuki: None. K. Tatsumi: None. K. Matsumoto: None. N. Emoto: None. K. Hirata: None.
- © 2014 by American Heart Association, Inc.