New echocardiographic prognostic factors for mortality in pulmonary arterial hypertension

AIMS: The present role of echocardiography is generally restricted to screening for pulmonary arterial hypertension (PAH). The aim of our study was to identify new echocardiographic prognostic factors for mortality in PAH which would give this imaging modality a genuine role in patient management. METHODS AND RESULTS: At inclusion, all patients underwent right cardiac catheterization and echocardiography. Seventy-nine patients were followed for a median of 12 months, of whom 16 died of their pulmonary disease. We identified seven echocardiographic parameters that were associated with mortality, four of which have not previously been described in the literature: mean pulmonary artery pressure (PAP) >or=49 mmHg (P = 0.012), dPAP >or= 29 mmHg (P = 0.006), abnormal end-diastolic septal curve (P = 0.027), and inferior vena cava diameter >or=20 mm with respiratory variation of diameter <50% (P = 0.018). These parameters remained significant after adjustment for NYHA class and 6 min walk test distance. CONCLUSION: Echocardiography should take an important place in the management of PAH and should not be restricted merely to screening for the disease.