Abstract 16651: Right Ventricular Effective Arterial Elastance is a Novel Predictor of Mortality in Pulmonary Hypertension Due to Left Heart Disease
Introduction: Patients with combined post- and pre-capillary pulmonary hypertension (CpcPH) due to left heart disease (PH-LHD) have worse prognosis compared with isolated post-capillary (IpcPH). Because patients with CpcPH usually have more severe PH than IpcPH, it remains unclear if increased mortality is a result of pulmonary vascular pathology or simply due to higher total right ventricular (RV) load. RV effective arterial elastance [Ea; end-systolic pressure (ESP) /stroke volume (SV)] is a measure of total RV afterload, reflecting both resistive and pulsatile components. In PH, ESP is best approximated by systolic pulmonary artery pressure (SPAP), and therefore Ea is defined as SPAP/SV.
Objectives: To evaluate if RV Ea predicts survival in PH-LHD and whether variables associated with pulmonary vascular pathology (pulmonary vascular resistance (PVR), transpulmonary gradient (TPG), diastolic pulmonary gradient (DPG)) are predictors of mortality after controlling for total RV load.
Methods: Out of 1236 patients previously evaluated for unexplained cardiomyopathy at our institution by right heart catheterization and endomyocardial biopsy, 467 had a complete set of hemodynamic variables and met criteria for PH-LHD. Patients were followed until death, cardiac transplantation or the end of the study period (mean time 4.4 years).
Results: SPAP/SV (Ea), PVR, TPG, and pulmonary artery compliance (PAC) were associated with mortality in unadjusted and adjusted analyses (Table). Additional models controlling for total RV load (Ea) attenuated the association between hemodynamic parameters and mortality [PVR (p=0.074), TPG (p=0.16), and DPG (p=0.15)]. Collinearity among the variables studied was not statistically significant.
Conclusions: In this retrospective analysis of patients with PH-LHD, Ea defined as SPAP/SV discriminates survivors from non-survivors. PVR, TPG, and DPG did not predict mortality after adjusting for total RV load (Ea).
Author Disclosures: E. Tampakakis: None. B.W. Kelemen: None. A. Shpigel: None. J. Rickard: None. P.J. Leary: None. E.K. Kasper: None. D.A. Kass: None. R.J. Tedford: Consultant/Advisory Board; Modest; merck.
- © 2014 by American Heart Association, Inc.