| Value of estimated right ventricular filling pressure in predicting cardiac events in chronic pulmonary arterial hypertension. | |
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MedLine Citation:
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PMID: 19944957 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Right ventricular (RV) filling pressure can be estimated using tissue Doppler imaging (TDI) from the tricuspid lateral annulus, but few data are available on the usefulness of Doppler-derived RV filling pressure in predicting the prognosis of chronic pulmonary arterial hypertension (PAH). METHODS: In 50 consecutive patients with PAH, TDI was performed within 24 hours of right-sided catheterization to measure early diastolic myocardial velocity at the tricuspid lateral annulus (E(a)) and early diastolic tricuspid inflow (E). The tricuspid E/E(a) ratio was calculated and compared with the invasive hemodynamic variables. Cardiac events were defined as cardiac death or rehospitalization due to RV failure. RESULTS: Mean right atrial pressure (RAP) averaged 6 +/- 5 mm Hg (range, 1-25 mm Hg). E/E(a) correlated positively with mean RAP (r = 0.80, P < .001), irrespective of RV systolic function. We divided patients into group A with cardiac events (n = 19) and group B without events (n = 31) in a mean follow-up period of 14 months. Plasma brain natriuretic peptide level and E/E(a) were significantly higher in group A than in group B (349 +/- 310 pg/dL vs 129 +/- 136 pg/dL, P = .001; 7.0 +/- 3.2 vs 4.5 +/- 1.9, P = .004, respectively), whereas mean pulmonary artery pressure did not differ significantly. In a multivariate model, E/E(a) remained predictive for cardiac events (hazard ratio 1.227; 95% confidence interval, 1.042-1.444; P = .014). An E/E(a) cutoff value of 6.8 discriminated cases with cardiac events with a sensitivity of 42% and specificity of 97% (area under the curve 0.71). CONCLUSION: The tricuspid E/E(a) ratio provides a reliable estimation of RV filling pressure and predicts cardiac events in patients with PAH. |
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Authors:
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Hiroto Utsunomiya; Satoshi Nakatani; Morikazu Nishihira; Hideaki Kanzaki; Shingo Kyotani; Norifumi Nakanishi; Yasuki Kihara; Masafumi Kitakaze |
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Publication Detail:
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Type: Evaluation Studies; Journal Article |
Journal Detail:
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Title: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography Volume: 22 ISSN: 1097-6795 ISO Abbreviation: J Am Soc Echocardiogr Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2009-11-30 Completed Date: 2010-02-22 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8801388 Medline TA: J Am Soc Echocardiogr Country: United States |
Other Details:
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Languages: eng Pagination: 1368-74 Citation Subset: IM |
Affiliation:
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Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Pressure Determination
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methods* Chronic Disease Echocardiography, Doppler / methods* Female Heart Ventricles / ultrasonography* Humans Hypertension, Pulmonary / complications*, ultrasonography* Image Interpretation, Computer-Assisted / methods* Male Middle Aged Reproducibility of Results Sensitivity and Specificity Ventricular Dysfunction, Right / etiology*, ultrasonography* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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