Assessment and Prognostic Relevance of Right Ventricular Contractile Reserve in Patients With Severe Pulmonary Hypertension

作者：Gruenig Ekkehard; Tiede Henning; Enyimayew Esi Otuwa; Ehlken Nicola; Seyfarth Hans Juergen; Bossone Eduardo; D' Andrea Antonello; Naeije Robert; Olschewski Horst; Ulrich Silvia; Nagel Christian; Halank Michael; Fischer Christine

来源：Circulation, 2013, 128(18): 2005-2015.

DOI：10.1161/CIRCULATIONAHA.113.001573

• hypertension
• pulmonary
• myocardial contraction
• risk factors
• survival

Background This study sought to analyze a new approach to assess exercise-induced pulmonary artery systolic pressure (PASP) increase by means of stress Doppler echocardiography as a possible measure of right ventricular contractile reserve in patients with severe pulmonary hypertension and right heart failure. %26lt;br%26gt;Methods and Results In this prospective study, patients with invasively diagnosed pulmonary arterial hypertension or inoperable chronic thromboembolic pulmonary hypertension and impaired right ventricular pump function despite a stable targeted pulmonary arterial hypertension medication underwent a broad panel of noninvasive assessments, including stress echocardiography and cardiopulmonary exercise testing. On the basis of the assumption that exercise-induced PASP is a measure of right ventricular contractile reserve, patients were classified into 2 groups according to an exercise-induced PASP increase above or below the median. Patients were followed up for 3.01.8 years. Univariate and multivariate analyses were used for factors predicting survival. Of 124 patients, 66 were below the median exercise-induced PASP increase of 30 mmHg (low PASP), and 58 patients were above the median (high PASP). These groups were not significantly different in terms of medication and resting hemodynamics. Low PASP was associated with a significantly lower 6-minute walking distance, peak (V) over doto(2) per kilogram, and 1-, 3-, and 4-year survival rates (92%, 69%, and 48%, respectively, versus 96%, 92%, and 89%). In the multivariate Cox model analysis adjusted for age and sex, PASP increase during exercise and peak (V) over doto(2) per kilogram remained independent prognostic markers (hazard ratio, 2.56 for peak (V) over doto(2) per kilogram and 2.84 for PASP increase). %26lt;br%26gt;Conclusions Exercise-induced PASP increase is of high clinical and prognostic relevance in pulmonary hypertension patients and may indicate right ventricular contractile reserve. Stress Doppler echocardiography may be a useful tool for prognostic assessment in pulmonary hypertension patients.

• 出版日期2013-10-29