Value of estimated right ventricular filling pressure in predicting cardiac events in chronic pulmonary arterial hypertension
| Autor: | Norifumi Nakanishi, Masafumi Kitakaze, Morikazu Nishihira, Shingo Kyotani, Hideaki Kanzaki, Yasuki Kihara, Satoshi Nakatani, Hiroto Utsunomiya |
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| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Heart Ventricles Hypertension Pulmonary Ventricular Dysfunction Right Hemodynamics Sensitivity and Specificity Internal medicine medicine.artery Image Interpretation Computer-Assisted Medicine Humans Radiology Nuclear Medicine and imaging E/A ratio business.industry Hazard ratio Central venous pressure Area under the curve Reproducibility of Results Blood Pressure Determination Middle Aged medicine.disease Pulmonary hypertension Confidence interval Echocardiography Doppler Pulmonary artery Chronic Disease cardiovascular system Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 22(12) |
| ISSN: | 1097-6795 |
| Popis: | Right ventricular (RV) filling pressure can be estimated using tissue Doppler imaging (TDI) from the tricuspid lateral annulus, but few data are available on the usefulness of Doppler-derived RV filling pressure in predicting the prognosis of chronic pulmonary arterial hypertension (PAH).In 50 consecutive patients with PAH, TDI was performed within 24 hours of right-sided catheterization to measure early diastolic myocardial velocity at the tricuspid lateral annulus (E(a)) and early diastolic tricuspid inflow (E). The tricuspid E/E(a) ratio was calculated and compared with the invasive hemodynamic variables. Cardiac events were defined as cardiac death or rehospitalization due to RV failure.Mean right atrial pressure (RAP) averaged 6 +/- 5 mm Hg (range, 1-25 mm Hg). E/E(a) correlated positively with mean RAP (r = 0.80, P.001), irrespective of RV systolic function. We divided patients into group A with cardiac events (n = 19) and group B without events (n = 31) in a mean follow-up period of 14 months. Plasma brain natriuretic peptide level and E/E(a) were significantly higher in group A than in group B (349 +/- 310 pg/dL vs 129 +/- 136 pg/dL, P = .001; 7.0 +/- 3.2 vs 4.5 +/- 1.9, P = .004, respectively), whereas mean pulmonary artery pressure did not differ significantly. In a multivariate model, E/E(a) remained predictive for cardiac events (hazard ratio 1.227; 95% confidence interval, 1.042-1.444; P = .014). An E/E(a) cutoff value of 6.8 discriminated cases with cardiac events with a sensitivity of 42% and specificity of 97% (area under the curve 0.71).The tricuspid E/E(a) ratio provides a reliable estimation of RV filling pressure and predicts cardiac events in patients with PAH. |
| Databáze: | OpenAIRE |
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