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Eur Heart J Cardiovasc Imaging. 2014 Dec;15(12):1411-9. doi: 10.1093/ehjci/jeu134. Epub 2014 Sep 8.

Clinical value of echocardiographic Doppler-derived right ventricular dp/dt in patients with pulmonary arterial hypertension.

Author information

1
Department of Cardiovascular Diseases, Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium koen.ameloot@uzleuven.be.
2
Department of Cardiovascular Diseases, Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.
3
Respiratory Division, University Hospitals Leuven, Leuven, Belgium.

Abstract

AIMS:

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).

METHODS AND 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).

CONCLUSION:

A reduced baseline RV dp/dt is a clear indicator of poor outcome independent of TAPSE in patients with PAH/CTEPH.

KEYWORDS:

Pulmonary hypertension; Right ventricular function

PMID:
25201651
DOI:
10.1093/ehjci/jeu134
[Indexed for MEDLINE]

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