Clinical Outcomes Study of Echocardiography Imaging to Define Relationship between Significant Pulmonary Hypertension and Right Ventricular Dysfunction: Indian Scenario

Objective: Pulmonary hypertension (PH) is one of the fundamental echocardiography parameters of prognostic importance in heart failure (HF) diseases. Recently, right ventricular (RV) function is being increasingly recognized as critical parameter in terms of mortality outcomes both in acute and chronic HF. We sought to determine the prognostic significance of PH and RV function in patients of acute and chronic HF from retrospective institutional data. Methodology: We studied 306 patients with HF presentation including acute decompensated HF. Pulmonary artery systolic pressure (PASP) and RV function were determined with the use of Doppler echocardiography, with PH as PASP >50 mmHg and tricuspid annular plane systolic excursion (TAPSE) <1.6 cm along with global RV fractional area change. The primary endpoint was all-cause mortality during 3-year follow-up. Results: PH was present in 134 patients (43.8%) and RV dysfunction in 129 patients (42.2%). The majority of patients with RV dysfunction had PH (58.1%). Patients with normal RV function and PH had an intermediate risk. However, patients with RV dysfunction without PH were not at increased risk for 3-year mortality. Conclusion: Critical echocardiography parameters in the evaluation of HF include PASP for pressure and volume overload status as well as RV function. The incremental prognosis is also determined by PH and RV function. The compounding effect of PH & RV dysfunction is detrimental in terms of high morbidity rates and mortality outcomes.