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Right Ventricular Function Predicts Clinical Response to Specific Vasodilator Therapy in Patients with Pulmonary Hypertension
Author(s) -
Giusca Sorin,
Jurcut Ruxandra,
Coman Ioan Mircea,
Ghiorghiu Ioana,
Catrina Daniela,
Popescu Bogdan A.,
Dima Laura,
Ginghina Carmen
Publication year - 2013
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.2012.01809.x
Subject(s) - medicine , sildenafil , bosentan , cardiology , pulmonary hypertension , ventricle , context (archaeology) , vasodilation , natriuretic peptide , heart failure , endothelin receptor , paleontology , receptor , biology
We followed patients with pulmonary arterial hypertension ( PAH ) receiving specific vasodilator therapy and tested for predictors of clinical outcome. Methods: Thirty‐two patients (mean age 39 ± 15 years, 22 women, diagnosed with pulmonary hypertension; PH ): 29 with PAH and 3 patients with inoperable chronic thromboembolic PH received therapy with either bosentan, sildenafil, or both and were evaluated with clinical parameters, biomarkers ( B ‐type natriuretic peptide values), and echocardiography before receiving specific medication and every 3 months thereafter. A right heart catheterization was performed at baseline. A composite endpoint of death, worsening of functional class, or the need of a second vasodilator agent was used to define the clinical nonresponders. Results: Patients were followed for 14 months (7.5–21). The endpoint was reached by 15 patients: four patients died (two idiopathic PAH and two PAH in context of E isenmenger syndrome), seven patients showed 1 functional class worsening, and four patients needed to be switched to combination therapy. Patients who remained clinically stable or improved had at baseline a better cardiac output with a less remodeled right ventricle ( RV ) and better functioning RV (all P < 0.05). A RV fractional area change ( RVFAC ) lower than 25.7% and a RV global strain value higher than −13.4% predict with 87% sensitivity and 83% specificity ( AUC 87.3%, P = 0.001) and 73% sensitivity and 91% specificity ( AUC 84.2%, P = 0.003), respectively, patients who will deteriorate clinically under specific vasodilator therapy. A multivariate model showed RVFAC to be the only independent predictor of the endpoint with a HR of 0.87 (0.8–0.96), P = 0.007. Conclusions: Over an average period of 1 year, almost half of patients showed signs of clinical deterioration despite specific vasodilator therapy. Parameters of right ventricular morphology and function had prognostic value in these patients.