Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension

• Published in: European heart journal Vol. 28; no. 10; pp. 1250 - 1257
• Main Authors: van Wolferen, Serge A., Marcus, Johannes T., Boonstra, Anco, Marques, Koen M.J., Bronzwaer, Jean G.F., Spreeuwenberg, Marieke D., Postmus, Pieter E., Vonk-Noordegraaf, Anton
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-05-2007; Oxford Publishing Limited (England)
• Subjects: Adult; Cardiac Catheterization; Exercise Test; Female; Follow-Up Studies; Heart Ventricles - physiopathology; Humans; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - mortality; Hypertension, Pulmonary - physiopathology; Magnetic Resonance Imaging, Cine; Male; Prognosis; Pulmonary Artery - physiopathology; Risk Factors; Stroke Volume; Survival Analysis; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Right - diagnosis; Prognosis; Magnetic resonance imaging; Right ventricle; Pulmonary hypertension
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehl477

Aims
This study investigated the relationship between right ventricular (RV) structure and function and survival in idiopathic pulmonary arterial hypertension (IPAH).
Methods and results
In 64 patients, cardiac magnetic resonance, right heart catheterization, and the six-minute walk test (6MWT) were performed at baseline and after 1-year follow-up. RV structure and function were analysed as predictors of mortality. During a mean follow-up of 32 months, 19 patients died. A low stroke volume (SV), RV dilatation, and impaired left ventricular (LV) filling independently predicted mortality. In addition, a further decrease in SV, progressive RV dilatation, and further decrease in LV end-diastolic volume (LVEDV) at 1-year follow-up were the strongest predictors of mortality. According to Kaplan-Meier survival curves, survival was lower in patients with an inframedian SV index ≤ 25 mL/m2, a supramedian RV end-diastolic volume index ≥ 84 mL/m2, and an inframedian LVEDV≤40 mL/m2.
Conclusions
The RV contains prognostic information in IPAH. A large RV volume, low SV, and a reduced LV volume are strong independent predictors of mortality and treatment failure.