Clinical and Echocardiographic Predictors of Outcomes in Patients With Pulmonary Hypertension

Irfan Siddiqui, Sudarshan Rajagopal, Amanda Brucker, Karen Chiswell, Bridgette Christopher, Fawaz Alenezi, Aditya Mandawat, Danny Rivera, Kristine Arges, Victor Tapson, Joseph Kisslo, Eric Velazquez, Pamela S. Douglas, Zainab Samad

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

Abstract

In pulmonary hypertension (PH), measurement of various echocardiographic parameters that assess right heart function is recommended by current clinical guidelines. Limited data exists on the combined value of clinical and echocardiographic parameters in precapillary PH in the modern era of therapy. We examined the association of clinical and echocardiographic parameters with surrogate outcomes (6-minute walk distance) and hard outcomes (hospitalization or death) in patients with precapillary PH. A cohort of patients with an established diagnosis of precapillary PH who underwent transthoracic echocardiography at the Duke Echo Lab were prospectively enrolled from 2010 to 2014. Univariable and multivariable models were constructed to examine the relation of clinical and echocardiographic parameters with surrogate and hard outcomes. Of the 98 patients with analyzable echocardiograms with good image quality, 85 were woman, mean age was 59.4 years, and 47% had ≥World Health Organization functional class III symptoms. The mean 6-minute walk distance was 354(±132) m, and 83% were on pulmonary arterial hypertension medications. At 24 months, the cumulative incidence rate for hospitalization or death was 47%. In univariable analyses, the REVEAL (Registry to Evaluate Early and Long-term PAH Disease Management) risk score (HR 1.72 per 1 SD (2.81) increment, 95% CI 1.34, 2.22; p=<0.001), RV global longitudinal strain (RVGLS) (HR 1.54 per 1 SD (5.31) worsening, 95% CI, 2.12; p=0.008) and log-2 NT proBNP (HR 1.43 per 1-fold increase, 95% CI 1.25, 1.63; p=<0.001) were significantly associated with hospitalization or death.

Original languageEnglish
Pages (from-to)872-878
Number of pages7
JournalAmerican Journal of Cardiology
Volume122
Issue number5
DOIs
Publication statusPublished - 1 Sept 2018
Externally publishedYes

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