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Right Index of Myocardial Performance (RIMP) as a Predictor of Death or Lung/Heart Transplantation in Patients with Pulmonary Hypertension (PH)

W. P. Abhayaratna

T. S. Tsang

K. Abhayaratna

S.A. Ness

J. A. Wiste

M. E. Barnes

J. Murphy

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Conference: 2006 International PHA Conference and Scientific Sessions

Release Date: 06.23.2006

Presentation Type: Abstracts

Abhayaratna WP, Tsang TS, Abhayaratna K, Ness S-A, Wiste JA, Barnes ME, Murphy JG.

Mayo Clinic, Rochester, USA

BACKGROUNDThe prognostic value of Doppler-echocardiography in patients with PH is incompletely characterized. We assessed the incremental value of selected right heart Doppler-echo parameters for the prediction of death or transplantation in patients with PH.

METHODSThis retrospective cohort study included 100 consecutive PH patients referred to the Mayo PH Clinic in 2000-2001. All had transthoracic echocardiography and a 6-min walk test. Cox regression analyses were used to assess predictors of death and/or heart-lung transplantation. RESULTS:  Twenty-seven patients had idiopathic pulmonary arterial hypertension; 49 had PH in association with recognized risk factors or predisposing conditions; 5 had left heart disease; 5 had parenchymal lung disease and/or severe hypoxia; 5 had pulmonary thromboembolic disease; and 9 had multiple contributing factors leading to increased pulmonary artery pressures. During a follow- up period of 3.8 ± 1.7 years, 42 patients died (n=36) or underwent transplantation (n=6). Baseline echocardiographic parameters and 6-min walk distance (6MWD), stratified by outcome status are displayed in the Table. 6MWD correlated with right ventricular systolic pressure (r=-0.24; p=0.02) and estimated right atrial pressure (r= -0.23; p=0.02), but was not associated with RIMP (r=0.03; p=0.72). In univariate analysis, 6MWD was the strongest predictor of adverse outcomes (chi-square 22; p<0.001). After adjusting for age (p=NS), gender (p=NS), pulmonary hypertension etiology (p=NS) and 6MWD (p<0.0001), RIMP was the only right heart Doppler-echo parameter to be incrementally predictive of death and/or transplantation [RIMP>0.62 (median value): HR 2.3; 95% CI 1.2 to 4.4; p=0.015].

CONCLUSIONDoppler-echo quantification of global right ventricular dysfunction with RIMP provides incremental information for the prediction of adverse outcomes in patients with pulmonary hypertension. The utility of RIMP as a prognostic tool and for monitoring the impact of medical therapy on outcomes warrants further investigation.                                                                                                

  Alive    Death/Transplantation

Right ventricular index of myocardial performance, (SD)*

0.56 (0.26)

0.66 (0.27)

Right ventricular systolic pressure, mmHg (SD)*

74 (26)

84 (20)

Ratio of right ventricular:systemic systolic pressure, (SD)*

0.59 (0.24)

0.69 (0.21)

Estimated right atrial pressure, mmHg (SD)*

12.3 (4.3)

14.0 (4.2)

6-min walk distance, m (SD)*

374 (89)

286 (96)

 

 

                                                                                                              (n=58)                          (n=42)                  

 *All tests for differences <0.001