Abstract 15871: Right Atrial Function Predicts Clinical Failure in Patients With Pulmonary Arterial Hypertension
Introduction: Right ventricular dysfunction is a well recognized determinant of survival in patients with pulmonary arterial hypertension (PAH). However, there is limited data on the role of right atrial (RA) function on the prognosis of PAH.
Hypothesis: The RA function, as expressed by RA function index (RAFi), a ratio that incorporates analogues of cardiac output and atrial reservoir and size, is of prognostic significance in PAH patients.
Methods: This was a prospective study that included consecutive patients with PAH. All patients underwent echocardiographic study. RA end systolic (RAESV) and end diastolic (RAEDV) volumes were calculated from apical 4 and 2 chamber views using the biplane Simpson’s method and indexed to the body surface area (BSA). The velocity-time integral of the pulmonary flow (PV-VTI) was calculated using pulsed-wave Doppler echocardiography. RAFi was calculated as follows: RAFi = (RAESV-RAEDV)*PV-VTI*BSA/RAESV2. Time from enrollment to first clinical event (death, hospitalization due to PAH, initiation of parenteral prostanoid therapy or atrial septostomy) was recorded for all patients.
Results: Our study included 43 consecutive patients with PAH (32 women, age 52.1±15.5 years). Over a median follow-up of 24.4 months (IQR 12.9-43.7 months) 19 patients had a clinical event. In Cox proportional hazard analysis, baseline RAFi was significantly related to the composite event (HR 0.917, 95% CI 0.853-0.986). ROC curve analysis showed that the optimal cut-off value of RAFi which predicted events was 12.3 (AUC 0.785, 95% CI 0.636-0.934). Kaplan-Meier survival analysis showed that RAFi ≤ 12.3 was associated with a 5.2-fold increased risk for clinical failure (Figure).
Conclusion: RA function is a predictor of clinical failure in patients with PAH.
Author Disclosures: S. Mouratoglou: None. G. Giannakoulas: Honoraria; Modest; MSD, Bayer, Pfizer, Menarini, GSK, Astra Zeneca, Actelion, Angelini, Boeringer, ELPEN Pharmaceutical, Lilly, Sanofi, Servier. V. Kamperidis: None. V. Grosomanidis: None. S. Hadjimiltiades: None. H. Karvounis: None.
- © 2016 by American Heart Association, Inc.