Abstract 20571: Early Change in Right Ventricular Function Assessed Echocardiographically Predicts Up to 17 Year Survival in Pulmonary Arterial Hypertension
Background: Baseline right ventricular (RV) function is a major determinant of outcome in patients with pulmonary arterial hypertension (PAH). However, the impact of changes in echo-assessed RV function on long-term survival remains uncertain.
Methods: Consecutive patients referred for initial hemodynamic evaluation of incident PAH by a single operator between 1998 and 2014 were prospectively enrolled. Demographics, echo data including qualitative RV function at baseline and after >1 year of follow-up, as well as invasive hemodynamics were recorded. RV function was graded on a scale of 0 to 3 (0=normal; 1=mildly reduced; 2=moderately reduced; 3=severely reduced). Changes were categorized as either improved/stable or worsened. Survival was determined through chart review and validated electronic medical record query tools. Kaplan-Meier methods were used to assess survival and mortality risk calculated using Cox proportional hazards modeling.
Results: Overall 147 patients with PAH (51% idiopathic, 34% congenital and 15% other) were included in the analysis, with mean follow-up of 4.5 years (range 1 to 17 years). Mean age of the cohort was 55 ± 15 years, and 69% were female. Median interval time between the echos was 1.5 years (IQR: 0.7-2.8). Subjects who had improved/stable function compared to worsened RV function had similar initial 6-minute walk distance (320 vs. 297 meters) and burden of NYHA class III/IV symptoms (61 vs. 66%), p>.3 for both. Risk for mortality was 2.6-fold higher in those patients whose RV function worsened over follow-up compared to those who improved (p=.0014, Figure).
Conclusion: In our cohort of patients with PAH, serial echo assessment of RV function from diagnosis to at least one year of follow-up strongly predicted longer-term survival. Changes in echo can therefore be used to identify high-risk patients and suggests a benefit to regular echo monitoring and support of RV function in PAH.
Author Disclosures: A.J. Blood: None. K. Parikh: None. T.M. Bashore: None. R.A. Krasuski: Consultant/Advisory Board; Modest; Actelion, Bayer.
- © 2016 by American Heart Association, Inc.