Right atrial size and tricuspid regurgitation severity predict mortality or transplantation in primary pulmonary hypertension.
Primary pulmonary hypertension (PPH) is a fatal illness. In advanced stages only transplantation is able to increase survival. Echocardiography is useful for the assessment of these patients, but there is limited information about its prognostic value. With this goal, 25 consecutive patients, age: 36.7 +/- 12.7 years, were studied and followed up for a mean period of 29 months (range: 0.2-84). Eleven echocardiographic parameters of cardiac anatomy, function, and hemodynamics were assessed. Age and sex were also analyzed. Death and heart-lung transplantation were considered end-points. Thirteen events (Death: 8; transplantation: 5) occurred in the follow-up (11 of 13 in the first year). Kaplan-Meier estimated survival free from transplantation at 5 years was 40% (95% CI: 23%-70%). In the univariate analysis, RAA (HR: 1.1, P =.0004), TR (HR: 2.7, P =.02), and RVET (HR: 0.98, P =.02) showed statistically significant relation with survival free from transplantation. Multivariate analysis showed that RAS (HR: 1.10, 95% CI: 1.04-1.17, P =.001) and TR (HR: 2.52, 95% CI: 1.01-6.3, P =.047) were independent risk factors of transplantation and death. The use of these findings on the management of patients with PPH should be tested in larger studies.
Bustamante-Labarta
Miguel
M
Echocardiography Section and Intrathoracic Organ Transplantation Division, ICYCC-Fundación Favaloro, Buenos Aires, Argentina. mbustamante@ffavaloro.org
Perrone
Sergio
S
De La Fuente
Ricardo Leon
RL
Stutzbach
Pablo
P
De La Hoz
Ricardo Perez
RP
Torino
Augusto
A
Favaloro
Roberto
R
D000054:Acceleration; D000328:Adult; D001118:Argentina / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D016041:Heart-Lung Transplantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D009929:Organ Size; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016278:Ventricular Function, Right / Q000502:physiology