title: Clinical value of echocardiographic Doppler-derived right ventricular dp/dt in patients with pulmonary arterial hypertension.
abstract: OBJECTIVE
  Right ventricular (RV) dp/dt is the instantaneous rate of RV pressure rise during early systole and is a surrogate marker of RV contractility. The main objective of this study was to evaluate the ability of echocardiographic Doppler obtained RV dp/dt to predict long-term survival in patients with pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension (CTEPH).
  
  
  RESULTS
  Seventy-eight consecutive newly diagnosed untreated patients (64 ± 15 years, 71% female, 57% PAH, 43% inoperable CTEPH) were included in the study. At baseline, patients were assessed clinically [New York Heart Association (NYHA) and 6 minutes walking distance (6MWD)], by transthoracic cardiac ultrasound and by right heart catherization. RV dp/dt was assessed using spectral Doppler recordings from the tricuspid regurgitation signal at a sweep speed of 200 mm/s by measuring the time interval in which the regurgitant velocity increased from 0.5 to 2 m/s. During a mean follow-up period of 3.5 ± 1.7 years, 31 patients died and 3 received a lung transplant [study endpoint reached in 34/78 (44%) patients]. The optimal RV dp/dt cut-off was determined by receiver operating characteristic analysis at 3 years to be 410 mmHg/s (specificity 84%, positive-predictive value 55%, and negative-predictive value 83%). In univariate analysis, RV dp/dt <410 mmHg/s (hazard ratio 2.67, 95% CI 1.30-5.47, P = 0.007), tricuspid annulus plane systolic excursion (TAPSE) <15 mm, NYHA, 6MWD, and right atrial pressure were predictors of mortality. In a multivariate model with TAPSE, RV dp/dt remained an independent predictor of mortality (P = 0.01).
  
  
  CONCLUSIONS
  A reduced baseline RV dp/dt is a clear indicator of poor outcome independent of TAPSE in patients with PAH/CTEPH.
authors.affiliation: Department of Cardiovascular Diseases, Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium koen.ameloot@uzleuven.be.
authors.forename: Koen
authors.initials: K
authors.lastname: Ameloot
authors.affiliation: Department of Cardiovascular Diseases, Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Pieter-Jan
authors.initials: PJ
authors.lastname: Palmers
authors.affiliation: Department of Cardiovascular Diseases, Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Alexander
authors.initials: A
authors.lastname: Vande Bruaene
authors.affiliation: Department of Cardiovascular Diseases, Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Annelies
authors.initials: A
authors.lastname: Gerits
authors.affiliation: Department of Cardiovascular Diseases, Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
authors.affiliation: Department of Cardiovascular Diseases, Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Voigt
authors.affiliation: Respiratory Division, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Marion
authors.initials: M
authors.lastname: Delcroix
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods; D004452:Echocardiography / Q000379:methods; D015150:Echocardiography, Doppler / Q000379:methods*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016138:Walking
keywords: Pulmonary hypertension; Right ventricular function