Abstract 20584: Clinical and Echocardiographic Predictors of Clinical Outcomes in Pulmonary Arterial Hypertension
Introduction: Various echocardiographic parameters reporting on right heart function are recommended by consensus documents but the relationship of these parameters with clinical outcomes is not clearly known.
Hypothesis: We hypothesized that echocardiographic parameters are associated with clinical outcomes (hospitalization + death) in patients with pulmonary arterial hypertension (PAH).
Methods: Patients with an established diagnosis of PAH undergoing transthoracic echocardiography (TTE) at the Duke Echo Lab were prospectively enrolled in the study from 2010 to 2014. A right heart-focused echocardiographic study was performed on all patients. Novel and traditional echocardiographic parameters were calculated using vendor-independent software. Univariable and multivariable Cox regression models were constructed to examine the relationship of clinical and echo parameters with outcomes.
Results: Of the 98 patients enrolled, 85 were female, mean age was 59.4 years and 47% had ≥ functional class III symptoms. The mean (SD) 6 minute walk distance (6MWD) was 353.6 (132.35) meters and 83% were on PAH medications. The mean (SD) REVEAL risk score, a scoring system for predicting survival in PAH, was 7.0 (2.81). Of the echocardiographic parameters, the mean (SD) RVGLS was -17.9% (5.31), RV fractional area change 32.7 (8.94), tricuspid annular plane systolic excursion 1.9 (0.56), and estimated RVSP 64.5 (19.2). By 24 months, 48% patients had been either hospitalized (n=29) or had died (n=12). In univariable analyses, only the REVEAL risk score (HR 1.2 per 1 point increase, 95% CI 1.1, 1.4; p=0.003), RVGLS (HR 1.1 per 1% worsening, 95% CI 1.04, 1.2; p=0.004), and LV systolic eccentricity index (HR 1.6; 95% CI 1.1, 2.2; p=0.011) were associated with outcome. Subjective assessment of RV function was not associated with outcome. While RVGLS provided little additional prognostic value beyond the REVEAL risk score, in a model adjusted for age, sex, WHO functional class, and heart rate, RVGLS was predictive of outcome (HR 1.14; 95% CI 1.04, 1.26; p=0006).
Conclusions: Of all the echocardiographic parameters recommended by consensus documents RVGLS provides prognostic information in patients with PAH. Larger studies are required to validate these findings.
Author Disclosures: I. Siddiqui: None. S. Rajagopal: None. A. Brucker: None. K. Chiswell: None. F. Al Enezi: None. D. Rivera: None. A. Mandawat: None. K. Arges: None. E. Velazquez: None. P. Douglas: None. Z. Samad: Research Grant; Modest; Gilead Sciences, Boston-Scientific-Duke Strategic Alliance for Research, Medtronic-Duke Strategic Alliance for Research.
- © 2016 by American Heart Association, Inc.