title: Comparison of patients with pulmonary arterial hypertension with versus without right-sided mechanical alternans.
abstract: The clinical implications of mechanical alternans in patients with pulmonary arterial hypertension (PAH) remain unknown. In this study, the prevalence, characteristics, and prognostic implications of mechanical alternans in patients with PAH were investigated. Thirty-two consecutive patients with PAH confirmed by cardiac catheterization from 2000 to 2010 were included in this cohort study. During cardiac catheterization, 8 patients (25%) showed mechanical alternans at rest. All alternans were detected in the right ventricle and pulmonary trunk. Serum level of brain natriuretic peptide (584 ± 177 vs 238 ± 252 pg/ml, p = 0.001), World Health Organization functional class (3.5 ± 0.5 vs 2.9 ± 0.4, p = 0.02), mean pulmonary arterial pressure (59 ± 10 vs 47 ± 18 mm Hg, p = 0.03), mean right atrial pressure (10 ± 4 vs 5 ± 4 mm Hg, p = 0.01), right ventricular end-diastolic pressure (15 ± 5 vs 9 ± 5 mm Hg, p = 0.01), and heart rate at catheterization (96 ± 17 vs 70 ± 11 beats/min, p = 0.003) were significantly higher in patients with alternans than in those without. Twelve-month mortality of patients with alternans was higher than in patients without alternans (p = 0.03): the 12-month survival rate after cardiac catheterization was 37% for the alternans group and 75% for the group without alternans. In conclusion, isolated right-sided mechanical alternans is not an uncommon event in patients with PAH. The existence of alternans is associated with the severity of PAH and right ventricular dysfunction and implies a poor prognosis in the short term.
authors.affiliation: Division of Cardiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. pigtailef45@yahoo.com
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ito
authors.forename: Makoto
authors.initials: M
authors.lastname: Kodama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kashimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Obata
authors.forename: Wataru
authors.initials: W
authors.lastname: Mitsuma
authors.forename: Satoru
authors.initials: S
authors.lastname: Hirono
authors.forename: Makoto
authors.initials: M
authors.lastname: Tomita
authors.forename: Yukako
authors.initials: Y
authors.lastname: Ohno
authors.forename: Naohito
authors.initials: N
authors.lastname: Tanabe
authors.forename: Yoshifusa
authors.initials: Y
authors.lastname: Aizawa
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization; D018450:Disease Progression; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D017725:Ventricular Pressure