Abstract 18038: Right Heart End-Systolic Remodeling Index Strongly Predicts Outcomes in Pulmonary Arterial Hypertension, Insights From a Network Analysis
Introduction: Indices of right heart end-systolic remodeling are emerging as prognostic markers in patients with pulmonary arterial hypertension (PAH). We hypothesized that right ventricular (RV) end-systolic remodeling indices would be incremental to well-validated scores in PAH.
Methods: From 2005 to 2014, 228 patients with PAH were prospectively enrolled. RV end-systolic remodeling index (RVESRI) was defined by RV lateral wall to septal length ratio. Network analysis of right heart metrics was performed using partial correlation diagrams. The incremental values of RV free wall longitudinal strain (RVLS) and RVESRI to well-validated risk scores such as the REVEAL registry were determined. The primary endpoint was death, lung transplant or readmission for heart failure. Correlates of endpoint were determined using Cox regression.
Results: Mean (±standard deviation) age was 49 ±14 years, 78% were female, 33% had connective tissue disease, 52% were in NYHA class III or IV, and mean resistance was 11±6 Wood units. RVESRI had strong and central connectivity with other metrics, including right atrial area index, strain and eccentricity index. The RVESRI to RV systolic pressure relationship enabled the discrimination of three groups of patients with either adapted, adversely-remodeled and severely adversely-remodeled right ventricles. Mean follow-up was 3.9 ±2.4 years. Event free survival (primary endpoint) was 90.6% at 1 year, 78.0% at 3 years and 64.8% at 5 years. Among previously validated clinical scores, the REVEAL score emerged as the strongest correlate of outcome at 3 years. In multivariate analysis, NYHA class III/IV, RVESRI, and log N-terminal-pro brain natriuretic peptide were retained (Chi-square 62.2, p<0.0001). RVESRI improved the predictive value of validated risk scores in a greater proportion than strain (p<0.01).
Conclusions: RVESRI has a central connectivity among RV metrics and provides incremental prognostic value to validated risk scores.
Author Disclosures: M. Amsallem: None. A.J. Sweatt: None. M. Aymami: None. T. Kuznetsova: None. O. Mercier: None. E. Fadel: None. M.V. McConnell: None. M. Rabinovitch: None. R. Zamanian: None. F. Haddad: None.
- © 2016 by American Heart Association, Inc.