Right ventricular phenotyping in incident patients with idiopathic pulmonary arterial hypertension.

Autor:	Ghio S; Division of Cardiology, Fondazione IRCCS Policlinico S Matteo, Pavia, Italy. Electronic address: s.ghio@smatteo.pv.it., Badagliacca R; Department of Clinical, Anesthesiological and Cardiovascular Sciences - Sapienza University of Rome, Rome, Italy., D'Alto M; Department of Cardiology, Monaldi Hospital - University 'L. Vanvitelli', Naples, Italy., Scelsi L; Division of Cardiology, Fondazione IRCCS Policlinico S Matteo, Pavia, Italy., Argiento P; Department of Cardiology, Monaldi Hospital - University 'L. Vanvitelli', Naples, Italy., Brunetti ND; Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy., Casu G; Division of Cardiology, Azienda Ospedaliero Universitaria, Sassari, Italy., Cedrone N; Unità di Medicina Interna, Ospedale S. Pertini., Rome, Italy., Confalonieri M; Pulmonology Unit, Heart-Thorax-Vessels Dept., University Hospital of Cattinara, Trieste, Italy., Corda M; Cardiology Unit, Azienda Ospedaliera 'G. Brotzu' San Michele, Cagliari, Italy., Correale M; Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy., D'Agostino C; Cardiology Department - University Hospital Policlinico Consorziale, Bari, Italy., De Tommasi E; Cardiology Department - University Hospital Policlinico Consorziale, Bari, Italy., Filomena D; Department of Clinical, Anesthesiological and Cardiovascular Sciences - Sapienza University of Rome, Rome, Italy., Galgano G; Department of Cardiology, 'F.Miulli' Hospital, Acquaviva delle Fonti, Bari, Italy., Greco A; Division of Cardiology, Fondazione IRCCS Policlinico S Matteo, Pavia, Italy., Grimaldi M; Department of Cardiology, 'F.Miulli' Hospital, Acquaviva delle Fonti, Bari, Italy., Lombardi C; Cardiologia, Università degli studi di Brescia, Brescia, Italy., Madonna R; Cardiology Unit, Department of Surgical, Medical, Molecular Pathology and Critical Area Medicine, University of Pisa - UNIPI, Pisa, Italy., Manzi G; Department of Clinical, Anesthesiological and Cardiovascular Sciences - Sapienza University of Rome, Rome, Italy., Mercurio V; Department of Translational Medical Sciences - Federico II University of Naples, Naples, Italy., Mihai A; Department of Clinical, Anesthesiological and Cardiovascular Sciences - Sapienza University of Rome, Rome, Italy., Mulè M; Cardiology Unit, IRCCS, Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy., Paciocco G; Dipartimento Cardio-Toraco-Vascolare, Clinica Pneumologica, Azienda Ospedaliera San Gerardo, Monza, Italy., Papa S; Department of Clinical, Anesthesiological and Cardiovascular Sciences - Sapienza University of Rome, Rome, Italy., Recchioni T; Department of Clinical, Anesthesiological and Cardiovascular Sciences - Sapienza University of Rome, Rome, Italy., Romaniello A; Cardiology Unit, S. Andrea Hospital, Rome, Italy., Romeo E; Department of Cardiology, Monaldi Hospital - University 'L. Vanvitelli', Naples, Italy., Stolfo D; Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy., Vitulo P; Pulmonology Unit, IRCCS - Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy., Benza RL; Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio., Vizza CD; Department of Clinical, Anesthesiological and Cardiovascular Sciences - Sapienza University of Rome, Rome, Italy.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2024 Oct; Vol. 43 (10), pp. 1668-1676. Date of Electronic Publication: 2024 Jun 26.
DOI:	10.1016/j.healun.2024.06.003
Abstrakt:	Background: Right ventricular (RV) imaging has not a definite role in risk stratification of pulmonary arterial hypertension (PAH) patients. We tested the hypothesis that echocardiography-derived phenotypes, depicting different degrees of RV remodeling and dysfunction, may provide additional prognostic information to current risk stratification tools. Methods: Consecutive incident PAH patients aged ≥18 years, diagnosed between January 2005 and December 2021, underwent clinical assessment, right heart catheterization, standard echocardiography. Simple echocardiographic variables were combined in order to define a priori four phenotypes representing different degrees of RV dilatation and RV-pulmonary arterial (PA) coupling: Phenotype 1 with mildy dilated right ventricle and preserved RV-PA coupling (n = 152 patients); phenotype 2 with mildly dilated right ventricle and poor RV-PA coupling (n = 143 patients); phenotype 3 with severely dilated right ventricle and preserved RV-PA coupling (n = 201 patients); phenotype 4 with severely dilated right ventricle and poor RV-PA coupling, with or without severe tricuspid regurgitation (n = 519 patients). Risk stratification was based on the European Society of Cardiology/European Respiratory Society (ESC/ERS) 3-strata model and Registry to Evaluate Early and Long-Term PAH disease Management (REVEAL) 2.0 score. Results: These phenotypes were present in all risk groups. Notably, regardless of the ESC/ERS risk stratum assigned to the patient, phenotype 4 was associated with a 2-fold increase of the odds of death (HR 2.1, 95% CI 1.6-2.8, p < 0.001), while phenotype 1 was associated with a 71% reduction in the odds of dying (HR 0.29, 95% CI 0.18-0.47, p < 0.001). Conclusions: Echocardiography-derived phenotypes describing RV remodeling and dysfunction may provide prognostic information which is independent of and additional to the clinically defined risk in incident PAH patients. (Copyright © 2024 International Society for the Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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