Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension.
OBJECTIVE
The aim of this study was to evaluate the relationships between echocardiographic findings and clinical outcomes in patients with severe primary pulmonary hypertension (PPH).


BACKGROUND
Primary pulmonary hypertension is associated with abnormalities of right heart structure and function that contribute to the poor prognosis of the disease. Echocardiographic abnormalities associated with PPH have been described, but the prognostic significance of these findings remains poorly characterized.


METHODS
Echocardiographic studies, invasive hemodynamic measurements and 6-min walk tests were performed and outcomes prospectively followed in 81 patients with severe PPH. Subjects were participants in a 12-week randomized trial examining the effects of prostacyclin plus conventional therapy compared with conventional therapy alone.


RESULTS
During the mean follow-up period of 36.9 +/- 15.4 months, 20 patients died and 21 patients underwent transplantation. Pericardial effusion (p = 0.003) and indexed right atrial area (p = 0.005) were predictors of mortality. Pericardial effusion (p = 0.017), indexed right atrial area (p = 0.012) and the degree of septal shift in diastole (p = 0.004) were predictors of a composite end point of death or transplantation. In multivariable analyses incorporating clinical, hemodynamic and echocardiographic variables, pericardial effusion and an enlarged right atrium remained predictors of adverse outcomes. Six-minute walk results, mixed venous oxygen saturation and initial treatment randomization were also independently associated with a poor prognosis.


CONCLUSIONS
Pericardial effusion, right atrial enlargement and septal displacement are echocardiographic abnormalities that reflect the severity of right heart failure and predict adverse outcomes in patients with severe PPH. These characteristics may help identify patients appropriate for more intensive medical therapy or earlier transplantation.
Raymond
Ronald J
RJ
University of North Carolina, Chapel Hill, North Carolina 27599-7075, USA.
Hinderliter
Alan L
AL
Willis
Park W
PW
Ralph
David
D
Caldwell
Edgar J
EJ
Williams
William
W
Ettinger
Neil A
NA
Hill
Nicholas S
NS
Summer
Warren R
WR
de Boisblanc
Bennett
B
Schwartz
Todd
T
Koch
Gary
G
Clayton
Linda M
LM
Jöbsis
Maria M
MM
Crow
James W
JW
Long
Walker
W
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016280:Atrial Function, Right / Q000502:physiology; D004452:Echocardiography; D011464:Epoprostenol / Q000627:therapeutic use; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D010490:Pericardial Effusion / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D013997:Time Factors; D016278:Ventricular Function, Right / Q000502:physiology
D000959:Antihypertensive Agents; D011464:Epoprostenol