Noninvasively assessed pulmonary artery stiffness predicts mortality in pulmonary arterial hypertension.
OBJECTIVE
Decreased total compliance of the pulmonary vascular bed is associated with increased mortality in patients with pulmonary arterial hypertension (PAH). We investigated whether proximal pulmonary artery stiffness, in terms of area distensibility and noninvasively assessed relative area change (RAC), calculated as relative cross-sectional area change, predicts mortality in patients with PAH.


RESULTS
Eighty-six subjects underwent right-heart catheterization and MRI to assess area distensibility and RAC. Patients were followed up to 48 months. Kaplan-Meier plot and Cox proportional hazards regression analyses assessed the predictive value of area distensibility and RAC. In 70 patients, the diagnosis PAH was confirmed, and 16 subjects served as control subjects. In comparison with control subjects, proximal pulmonary arteries of patients were distended (685 +/- 214 mm2 vs 411 +/- 153 mm2, p < 0.001), less distensible (area distensibility = 0.46 +/- 0.38.10(-2) mm Hg(-1) vs 3.69 +/- 1.96.10(-2) mm Hg(-1), p < 0.0001), and RAC was smaller (20 +/- 10% vs 58 +/- 21%, p < 0.0001) [mean +/- SD]. RAC showed an inverse curvilinear relation with mean pulmonary artery pressure (R2 = 0.47). Eighteen patients (26%) died because of cardiopulmonary causes. Patients with a pulmonary artery RAC <or= 16% had a worse prognosis than those with a value > 16% (log-rank p < 0.001). RAC predicted mortality better than area distensibility.


CONCLUSIONS
Noninvasively measured pulmonary artery RAC predicts mortality in patients with PAH.
Gan
C Tji-Joong
CT
Department of Pulmonary Diseases, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
Lankhaar
Jan-Willem
JW
Westerhof
Nico
N
Marcus
J Tim
JT
Becker
Annemarie
A
Twisk
Jos W R
JW
Boonstra
Anco
A
Postmus
Pieter E
PE
Vonk-Noordegraaf
Anton
A
D000328:Adult; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D004548:Elasticity; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality* / Q000503:physiopathology*; D016018:Least-Squares Analysis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology*