title: Right-heart function related to the results of acute pulmonary vasodilator testing in patients with pulmonary arterial hypertension caused by connective tissue disease.
abstract: BACKGROUND
  Acute pulmonary vasodilator testing is important for patients with pulmonary arterial hypertension, but little is known about the predictors of response to such testing.
  
  
  METHODS
  Forty-eight patients (mean age, 41.3 ± 11.6 years; 91.7% women) with pulmonary arterial hypertension associated with connective tissue diseases who underwent right-heart catheterization and acute pulmonary vasodilator testing were prospectively recruited. Echocardiography was performed before and immediately after testing.
  
  
  RESULTS
  There were 14 responders (29.2%) to acute pulmonary vasodilator testing. Responders had lower pulmonary vascular resistance, higher peak systolic velocity of the lateral tricuspid valve annulus (right ventricular [RV] S') and tricuspid annular plane systolic excursion, and smaller RV end-diastolic area. After vasodilator testing, mean pulmonary artery pressure and pulmonary vascular resistance decreased significantly in both groups, cardiac index increased significantly in responders, and RV function improved significantly in nonresponders. Receiver operating characteristic curve analysis identified an optimal cutoff value for RV S' of ≥10.5 cm/sec to predict response, with sensitivity of 71% and specificity of 71%. There were more responders among patients with RV S' ≥ 10.5 cm/sec (45.5% vs 15.4%, P = .02). On multivariate logistic regression analysis, RV S' ≥ 10.5cm/sec emerged as an independent predictor of response (odds ratio, 4.58; 95% confidence interval, 1.18-17.79; P = .02).
  
  
  CONCLUSIONS
  Right-heart function is better in responders to acute pulmonary vasodilator testing than in nonresponders among patients with pulmonary arterial hypertension associated with connective tissue diseases, and pulmonary vasodilators may improve RV function in nonresponders and cardiac index in responders. RV S' is a simple and clinically useful tool for predicting the results of pulmonary vasodilator testing.
authors.affiliation: Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Yong-Tai
authors.initials: YT
authors.lastname: Liu
authors.forename: Meng-Tao
authors.initials: MT
authors.lastname: Li
authors.forename: Quan
authors.initials: Q
authors.lastname: Fang
authors.forename: Zhuang
authors.initials: Z
authors.lastname: Tian
authors.forename: Xiao-Xiao
authors.initials: XX
authors.lastname: Guo
authors.forename: Wen-Ling
authors.initials: WL
authors.lastname: Zhu
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Zeng
mesh_terms: D000328:Adult; D003240:Connective Tissue Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D005080:Exercise Test; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012372:ROC Curve; D013599:Systole; D013997:Time Factors; D018608:Ultrasonography, Doppler / Q000295:instrumentation; D014655:Vascular Resistance / Q000502:physiology*; D014664:Vasodilation / Q000187:drug effects*; D014665:Vasodilator Agents / Q000627:therapeutic use; D016278:Ventricular Function, Right / Q000502:physiology
chemical_list: D014665:Vasodilator Agents