title: Value of estimated right ventricular filling pressure in predicting cardiac events in chronic pulmonary arterial hypertension.
abstract: BACKGROUND
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  The tricuspid E/E(a) ratio provides a reliable estimation of RV filling pressure and predicts cardiac events in patients with PAH.
authors: Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
authors: Hiroto
authors: H
authors: Utsunomiya
authors: Satoshi
authors: S
authors: Nakatani
authors: Morikazu
authors: M
authors: Nishihira
authors: Hideaki
authors: H
authors: Kanzaki
authors: Shingo
authors: S
authors: Kyotani
authors: Norifumi
authors: N
authors: Nakanishi
authors: Yasuki
authors: Y
authors: Kihara
authors: Masafumi
authors: M
authors: Kitakaze
mesh_terms: D001795:Blood Pressure Determination / Q000379:methods*; D002908:Chronic Disease; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology*