Premium
Right and left heart dysfunction predict mortality in pulmonary hypertension
Author(s) -
Henein Michael Y.,
Grönlund Christer,
Tossavainen Erik,
Söderberg Stefan,
Gonzalez Manuel,
Lindqvist Per
Publication year - 2017
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12266
Subject(s) - medicine , cardiology , pulmonary hypertension , pulmonary artery , speckle tracking echocardiography , regurgitation (circulation) , heart failure , doppler echocardiography , subclinical infection , cohort , blood pressure , diastole , ejection fraction
Summary In pulmonary hypertension ( PH ), the right heart dysfunction is a strong predictor of adverse clinical outcome, while the role of the left heart is not fully determined. The aim of this study was to identify predictors of mortality in precapillary PH including measures of both right and left heart function. We studied 34 patients (mean age 64 ± 13, range 31–82 years, 24 females) with precapillary PH , all of whom underwent detailed Doppler echocardiographic examination of the right and left heart function using conventional and speckle‐tracking echocardiography. Patients were followed up for up to 8 years (mean 4·2 ± 1·9 years). At follow‐up, 16 patients survived. Left ventricular ( LV ) filling time ( P = 0·007), pulmonary artery acceleration time ( P = 0·009), right atrial pressure ( RAP ) ( P <0·001) and tricuspid regurgitation ( TR ) severity ( P = 0·007) were worse in the deceased group. RV global longitudinal strain ( GLS ) ( P = 0·001), RAP ( P ≤0·001), LV filling time ( P <0·001) and TR severity ( P <0·001) were the most accurate predictors, having the largest AUC (>0·65) and carried the highest risk for mortality ( P <0·001 for all). The strongest predictors of mortality in precapillary PH indirectly reflect both left and right heart dysfunction including atrial structure and function disturbances. While an interaction pattern is observed, it needs to be confirmed in a larger cohort.