Baseline right ventricular dp/dt <410 mmHg/s predicted mortality or lung transplant in patients with PAH or CTEPH (HR 2.67; 95% CI 1.30-5.47; P=0.007), independent of TAPSE.
Cohort (n=78)
Does echocardiographic Doppler-derived RV dp/dt predict long-term survival in patients with PAH and CTEPH?
A reduced baseline echocardiographic RV dp/dt (<410 mmHg/s) is an independent predictor of poor long-term outcomes in patients with PAH and CTEPH, providing prognostic value beyond TAPSE.
Effect estimate: HR 2.67 (95% CI 1.30-5.47)
p-value: p=0.007
AIMS: Right ventricular (RV) dp/dt is the instantaneous rate of RV pressure rise during early systole and is a surrogate marker of RV contractility. The main objective of this study was to evaluate the ability of echocardiographic Doppler obtained RV dp/dt to predict long-term survival in patients with pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension (CTEPH). METHODS AND RESULTS: Seventy-eight consecutive newly diagnosed untreated patients (64 ± 15 years, 71% female, 57% PAH, 43% inoperable CTEPH) were included in the study. At baseline, patients were assessed clinically New York Heart Association (NYHA) and 6 minutes walking distance (6MWD), by transthoracic cardiac ultrasound and by right heart catherization. RV dp/dt was assessed using spectral Doppler recordings from the tricuspid regurgitation signal at a sweep speed of 200 mm/s by measuring the time interval in which the regurgitant velocity increased from 0.5 to 2 m/s. During a mean follow-up period of 3.5 ± 1.7 years, 31 patients died and 3 received a lung transplant study endpoint reached in 34/78 (44%) patients. The optimal RV dp/dt cut-off was determined by receiver operating characteristic analysis at 3 years to be 410 mmHg/s (specificity 84%, positive-predictive value 55%, and negative-predictive value 83%). In univariate analysis, RV dp/dt <410 mmHg/s (hazard ratio 2.67, 95% CI 1.30-5.47, P = 0.007), tricuspid annulus plane systolic excursion (TAPSE) <15 mm, NYHA, 6MWD, and right atrial pressure were predictors of mortality. In a multivariate model with TAPSE, RV dp/dt remained an independent predictor of mortality (P = 0.01). CONCLUSION: A reduced baseline RV dp/dt is a clear indicator of poor outcome independent of TAPSE in patients with PAH/CTEPH.
Ameloot et al. (Mon,) conducted a cohort in Pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension (CTEPH) (n=78). Echocardiographic Doppler-derived right ventricular dp/dt <410 mmHg/s vs. Right ventricular dp/dt ≥410 mmHg/s was evaluated on Mortality or lung transplant (HR 2.67, 95% CI 1.30-5.47, p=0.007). Baseline right ventricular dp/dt <410 mmHg/s predicted mortality or lung transplant in patients with PAH or CTEPH (HR 2.67; 95% CI 1.30-5.47; P=0.007), independent of TAPSE.