title: Echocardiographic and Hemodynamic Predictors of Survival in Precapillary Pulmonary Hypertension: Seven-Year Follow-Up.
abstract: BACKGROUND
  In this study, we looked at the prognostic value of echocardiographic and hemodynamic measures in a large cohort of patients with precapillary pulmonary hypertension before and after initiation of treatment.
  
  
  RESULTS
  Data were collected prospectively in a cohort of consecutive patients with precapillary pulmonary hypertension referred between 2002 and 2011. A range of clinical and echocardiographic variables were collected and stored on a database to assess predictors of survival. Invasive hemodynamic data including pulmonary artery pressure, pulmonary vascular resistance, capillary wedge pressure, and cardiac index were also obtained at baseline in all patients. Outcome was defined as mortality because of cardiovascular-related death. The study cohort comprised 777 patients (514 women) with precapillary pulmonary hypertension. A total of 195 (25%) died. In multivariable analysis, moderate or severe tricuspid regurgitation (hazard ratio [HR], 26.537; 95% confidence interval, 11.536-61.044; P<0.001), right ventricular myocardial performance index (HR, 3.421; 95% confidence interval, 1.777-6.584; P<0.001), and the presence of pericardial effusion (HR, 1.38; 95% confidence interval, 1.023-1.862; P=0.035) were independent predictors of mortality. High pulmonary vascular resistance and right atrial pressure by invasive hemodynamic measurements were independent predictors of mortality (HR, 1.084; 95% confidence interval, 1.041-1.130, and 1.079, respectively; 95% confidence interval, 1.049-1.111; P<0.001 for both), whereas patients with a higher cardiac index had better survival overall (HR, 0.384; 95% confidence interval, 0.307-0.481; P<0.001).
  
  
  CONCLUSIONS
  Right ventricular dysfunction, moderate-severe tricuspid regurgitation, low cardiac index, and raised right atrial pressure were associated with poor survival for both pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertensive disease patients. The severity of tricuspid regurgitation, myocardial performance index, presence of pericardial effusion, pulmonary vascular resistance, cardiac index, and right atrial pressure may be used to stratify risk of death.
authors.affiliation: From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.).
authors.forename: Julia
authors.initials: J
authors.lastname: Grapsa
authors.affiliation: From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.).
authors.forename: Maria Carmo
authors.initials: MC
authors.lastname: Pereira Nunes
authors.affiliation: From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.).
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Tan
authors.affiliation: From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.).
authors.forename: Ines Zimbarra
authors.initials: IZ
authors.lastname: Cabrita
authors.affiliation: From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.).
authors.forename: Taryn
authors.initials: T
authors.lastname: Coulter
authors.affiliation: From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.).
authors.forename: Benjamin C F
authors.initials: BC
authors.lastname: Smith
authors.affiliation: From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.).
authors.forename: David
authors.initials: D
authors.lastname: Dawson
authors.affiliation: From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.).
authors.forename: J Simon R
authors.initials: JS
authors.lastname: Gibbs
authors.affiliation: From the Department of Cardiology, Hammersmith Hospital, Imperial College London, United Kingdom (J.G., T.C., B.C.F.S., D.D., P.N.); Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston (M.C.P.N., T.C.T.); and National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (I.Z.C., J.S.R.G.). petros@imperial.ac.uk.
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D008131:London / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D016019:Survival Analysis; D014655:Vascular Resistance / Q000502:physiology
keywords: echocardiography; pericardial effusion; pulmonary hypertension; right ventricular function; survival analysis