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Risk classification of pulmonary arterial hypertension by echocardiographic combined assessment of pulmonary vascular resistance and right ventricular function

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Abstract

Which combination of clinical parameters improves the prediction of prognosis in patients with pulmonary arterial hypertension (PAH) remains unclear. We examined whether combined assessment of pulmonary vascular resistance and right ventricular function by echocardiography is useful for classifying risks in PAH. In 41 consecutive patients with PAH (mean age of 48.9 ± 17.3 years, 31 females), a 6-min walk test, pulmonary function test, and echocardiography were performed at baseline and during PAH-specific therapies. The study endpoint was defined as a composite of cardiovascular death and hospitalization for PAH and/or right ventricular failure. During a follow-up period of 9.2 ± 8.7 months, 18 patients reached the endpoint. Multivariate regression analysis showed that the ratio of tricuspid regurgitation pressure gradient to the time–velocity integral of the right ventricular outflow tract (TRPG/TVI) and tricuspid annular plane systolic excursion (TAPSE) during PAH-specific treatment were independent prognostic predictors of the endpoint. Using cutoff values indicated by receiver operating characteristic analysis, the patients were divided into four subsets. Multivariate analyses by Cox's proportional hazards model adjusted for age, sex and body mass index indicated that subset 4 (TRPG/TVI ≥ 3.89 and TAPSE ≤ 18.9 mm) had a significantly higher event risk than did subset 1 (TRPG/TVI < 3.89 and TAPSE > 18.9 mm): HR = 25.49, 95% CI 4.70–476.97, p < 0.0001. Combined assessment of TRPG/TVI and TAPSE during adequate PAH-specific therapies enables classification of risks for death and/or progressive right heart failure in PAH.

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Authors and Affiliations

  1. Department of Cardiovascular Internal Medicine, Obihiro-Kosei General Hospital, Obihiro, Japan

    Mina Kawamukai & Junichi Nishida

  2. Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan

    Mina Kawamukai, Akiyoshi Hashimoto, Masayuki Koyama, Nobutaka Nagano, Atsushi Mochizuki, Hidemichi Kouzu, Atsuko Muranaka, Nobuaki Kokubu, Daigo Nagahara, Kazufumi Tsuchihashi & Tetsuji Miura

  3. Division of Health Care Administration and Management, Sapporo Medical University School of Medicine, Sapporo, Japan

    Akiyoshi Hashimoto & Kazufumi Tsuchihashi

  4. Division of Cardiology, Teine-Keijinkai Hospital, Cardiovascular Center, Sapporo, Japan

    Satoshi Yuda

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  1. Mina Kawamukai
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  2. Akiyoshi Hashimoto
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  3. Masayuki Koyama
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Correspondence to Akiyoshi Hashimoto.

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Kawamukai, M., Hashimoto, A., Koyama, M. et al. Risk classification of pulmonary arterial hypertension by echocardiographic combined assessment of pulmonary vascular resistance and right ventricular function. Heart Vessels 34, 1789–1800 (2019). https://doi.org/10.1007/s00380-019-01429-7

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