Determinants of right ventricular ejection fraction in pulmonary arterial hypertension.
BACKGROUND
Right ventricular function is a key determinant of exercise capacity and survival in pulmonary arterial hypertension (PAH). We aimed to study the predictors of right ventricular ejection fraction (RVEF) in patients with newly diagnosed PAH.


METHODS
We performed a cross-sectional analysis of a retrospective cohort of consecutive patients with idiopathic, familial, or anorexigen-associated PAH who underwent equilibrium radionuclide angiography for measurement of RVEF at baseline.


RESULTS
Of the 84 patients in the cohort, 63 underwent equilibrium radionuclide angiography and right heart catheterization and were included. The mean age was 41 +/- 13 years, and 79% of the patients were female. The mean RVEF was 30 +/- 8%. RVEF was directly associated with right ventricular stroke volume index and cardiac index, and inversely associated with pulmonary vascular resistance index from right heart catheterization (all p < 0.001). Older age and male sex were associated with lower RVEF (p < 0.05) after adjustment for pulmonary vascular resistance index and left ventricular ejection fraction. Higher plasma von Willebrand factor levels were also independently associated with lower RVEF (p = 0.01) (n = 55). Body size and type of PAH were not associated with RVEF.


CONCLUSIONS
Older patients and males with PAH had lower RVEF at baseline than younger patients and females, even after controlling for left ventricular function and hemodynamics. Higher plasma von Willebrand factor levels, a marker of endothelial dysfunction, were also associated with lower RVEF.
Kawut
Steven M
SM
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY. Electronic address: kawut@mail.med.upenn.edu.
Al-Naamani
Nadine
N
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.
Agerstrand
Cara
C
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.
Berman Rosenzweig
Erika
E
Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY.
Rowan
Cherise
C
Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY.
Barst
Robyn J
RJ
Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY.
Bergmann
Steven
S
Department of Medicine, Beth Israel Medical Center, New York, NY.
Horn
Evelyn M
EM
Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY.
D000328:Adult; D006328:Cardiac Catheterization; D002302:Cardiac Output; D005260:Female; D015637:Gated Blood-Pool Imaging; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017380:Hypertrophy, Right Ventricular; D008297:Male; D013318:Stroke Volume; D014655:Vascular Resistance; D016278:Ventricular Function, Right