title: Echocardiographic predictors of mortality in patients with pulmonary hypertension and cardiopulmonary comorbidities.
abstract: OBJECTIVE
  We aimed to identify the echocardiographic measures associated with survival in a patient population with a high prevalence of co-morbid cardiovascular and pulmonary disease that have significantly elevated estimated pulmonary artery systolic pressures (ePASP).
  
  
  BACKGROUND
  Pulmonary hypertension (PH) is a clinical feature of several cardiopulmonary diseases that are prevalent among elderly. While certain echocardiographic parameters have been shown to be important in the prognosis in specific PH groups, the prognostic relevance of echocardiographic characteristics in a cohort with multiple cardiopulmonary comorbidities is unclear.
  
  
  METHODS
  We retrospectively identified 152 patients with ePASP > 60 mmHg by echocardiography over a five year period (6/2006-11/2011) and followed until 4/2013. Candidate clinical and echocardiographic characteristics suggestive of PH severity were compared between deceased and surviving subpopulations. Cox proportional hazard modeling was used to identify echocardiographic predictors of death adjusted for age and clinical characteristics.
  
  
  RESULTS
  This was a predominantly elderly (age 78.8 ± 10.2 years), male (98.7%) cohort with several cardiopulmonary comorbidities. Overall mortality was high (69.7%, median survival 129 days). After adjusting for age and clinical characteristics, decreased right ventricular (RV) systolic function assessed by tricuspid annular plane systolic excursion (HR 0.56, 95% CI 0.33-0.96, p = 0.034) and increased RV thickness (HR: 4.34, 95% CI: 1.49-12.59, p = 0.007) were independently associated with mortality. In contrast, left ventricular systolic function, left ventricular diastolic parameters, ePASP, or echo-derived pulmonary vascular resistance (PVR) were not associated with increased mortality.
  
  
  CONCLUSIONS
  In a cohort of patients with PH and high prevalence of cardio-pulmonary comorbidities, RV systolic function and hypertrophy are associated with mortality and may be the most relevant echocardiographic markers for prognosis.
authors.affiliation: Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Johannes
authors.initials: J
authors.lastname: Steiner
authors.affiliation: Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Wen-Chih
authors.initials: WC
authors.lastname: Wu
authors.affiliation: Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Matthew
authors.initials: M
authors.lastname: Jankowich
authors.affiliation: Veterans Affairs Boston Healthcare System, Department of Cardiology, Boston, Massachusetts, United States of America; Brigham and Women's Hospital and Harvard Medical School, Department of Internal Medicine, Division of Cardiovascular Medicine, Boston, Massachusetts, United States of America.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Maron
authors.affiliation: Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Satish
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Vascular Research Laboratory, Providence VA Medical Center, Providence, Rhode Island, United States of America; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Choudhary
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000473:pathology; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D011379:Prognosis; D011660:Pulmonary Heart Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology*; D012189:Retrospective Studies; D016019:Survival Analysis; D017725:Ventricular Pressure