title: Right and left heart dysfunction predict mortality in pulmonary hypertension.
abstract: In pulmonary hypertension (PH), the right heart dysfunction is a strong predictor of adverse clinical outcome, while the role of the left heart is not fully determined. The aim of this study was to identify predictors of mortality in precapillary PH including measures of both right and left heart function. We studied 34 patients (mean age 64 ± 13, range 31-82 years, 24 females) with precapillary PH, all of whom underwent detailed Doppler echocardiographic examination of the right and left heart function using conventional and speckle-tracking echocardiography. Patients were followed up for up to 8 years (mean 4·2 ± 1·9 years). At follow-up, 16 patients survived. Left ventricular (LV) filling time (P = 0·007), pulmonary artery acceleration time (P = 0·009), right atrial pressure (RAP) (P<0·001) and tricuspid regurgitation (TR) severity (P = 0·007) were worse in the deceased group. RV global longitudinal strain (GLS) (P = 0·001), RAP (P≤0·001), LV filling time (P<0·001) and TR severity (P<0·001) were the most accurate predictors, having the largest AUC (>0·65) and carried the highest risk for mortality (P<0·001 for all). The strongest predictors of mortality in precapillary PH indirectly reflect both left and right heart dysfunction including atrial structure and function disturbances. While an interaction pattern is observed, it needs to be confirmed in a larger cohort.
authors.affiliation: Department of Cardiology, Heart Centre, Umeå University, Umeå, Sweden.|Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Henein
authors.affiliation: Department of Biomedical Engineering - R&D, Radiation sciences, Umeå University, Umeå, Sweden.
authors.forename: Christer
authors.initials: C
authors.lastname: Grönlund
authors.affiliation: Department of Cardiology, Heart Centre, Umeå University, Umeå, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Tossavainen
authors.affiliation: Department of Cardiology, Heart Centre, Umeå University, Umeå, Sweden.|Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Söderberg
authors.affiliation: Department of Cardiology, Heart Centre, Umeå University, Umeå, Sweden.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gonzalez
authors.affiliation: Department of Clinical Physiology, Heart Centre, Umeå University, Umeå, Sweden.|Department of Surgical and Peri-Operative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Lindqvist
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016279:Atrial Function, Left; D016280:Atrial Function, Right; D006328:Cardiac Catheterization; D018450:Disease Progression; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: Doppler echocardiography; diastolic function; left heart function; precapillary pulmonary hypertension; right heart function