High-risk echocardiographic features predict mortality in pulmonary arterial hypertension

Christopher Austin, Charles Dwayne Burger, Garvan M Kane, Robert Safford, Joseph Blackshear, Ryan Ung, Jordan Ray, Ali Alsaad, Khadija Alassas, Brian P Shapiro

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Aims Echocardiography is the most common imaging modality for assessment of the right ventricle in patients with pulmonary arterial hypertension (PAH). Echocardiographic parameters were identified as independent risk factors for mortality in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) and other PAH cohorts. We sought to identify readily obtained echocardiographic features associated with PAH survival. Methods and results Retrospective analysis of 175 patients with Group 1 was performed. Baseline clinical and laboratory assessment including REVEAL risk criteria were obtained and standard 2-Dimensional and Doppler echocardiography performed at baseline was reviewed. Univariate and multivariate analyses of echocardiographic parameters were performed. Estimated right atrial pressure> 15 mmHg (HR 2.39, P =.02), tricuspid regurgitation ≥ moderate (HR 2.16, P =.04), and presence of pericardial effusion (HR 1.8, P =.05) were identified as independent, high-risk echocardiographic features in PAH. A validation cohort of 677 patients was identified and Kaplan–Meier survival analysis was performed in both cohorts. High-risk echocardiographic features stratified survival curves of both cohorts (P <.01 for all). The presence of 3 high-risk echocardiographic features greatly increased risk of 1-year (RR 4.86) and 3-year (RR 3.35) mortality (P <.05 for both). Conclusion Estimated right atrial pressure> 15, tricuspid regurgitation ≥ moderate, and presence of pericardial effusion are high-risk echocardiographic features in PAH. When seen in combination, these features greatly increase risk of mortality in PAH and may lead to more timely enhanced therapy for patients identified as having an increased risk for death.

Original languageEnglish (US)
Pages (from-to)167-176
Number of pages10
JournalAmerican Heart Journal
Volume189
DOIs
StatePublished - Jul 1 2017

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Pulmonary Hypertension
Mortality
Tricuspid Valve Insufficiency
Pericardial Effusion
Atrial Pressure
Survival
Doppler Echocardiography
Survival Analysis
Disease Management
Heart Ventricles
Registries
Echocardiography
Multivariate Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

High-risk echocardiographic features predict mortality in pulmonary arterial hypertension. / Austin, Christopher; Burger, Charles Dwayne; Kane, Garvan M; Safford, Robert; Blackshear, Joseph; Ung, Ryan; Ray, Jordan; Alsaad, Ali; Alassas, Khadija; Shapiro, Brian P.

In: American Heart Journal, Vol. 189, 01.07.2017, p. 167-176.

Research output: Contribution to journalArticle

Austin, Christopher ; Burger, Charles Dwayne ; Kane, Garvan M ; Safford, Robert ; Blackshear, Joseph ; Ung, Ryan ; Ray, Jordan ; Alsaad, Ali ; Alassas, Khadija ; Shapiro, Brian P. / High-risk echocardiographic features predict mortality in pulmonary arterial hypertension. In: American Heart Journal. 2017 ; Vol. 189. pp. 167-176.
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abstract = "Aims Echocardiography is the most common imaging modality for assessment of the right ventricle in patients with pulmonary arterial hypertension (PAH). Echocardiographic parameters were identified as independent risk factors for mortality in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) and other PAH cohorts. We sought to identify readily obtained echocardiographic features associated with PAH survival. Methods and results Retrospective analysis of 175 patients with Group 1 was performed. Baseline clinical and laboratory assessment including REVEAL risk criteria were obtained and standard 2-Dimensional and Doppler echocardiography performed at baseline was reviewed. Univariate and multivariate analyses of echocardiographic parameters were performed. Estimated right atrial pressure> 15 mmHg (HR 2.39, P =.02), tricuspid regurgitation ≥ moderate (HR 2.16, P =.04), and presence of pericardial effusion (HR 1.8, P =.05) were identified as independent, high-risk echocardiographic features in PAH. A validation cohort of 677 patients was identified and Kaplan–Meier survival analysis was performed in both cohorts. High-risk echocardiographic features stratified survival curves of both cohorts (P <.01 for all). The presence of 3 high-risk echocardiographic features greatly increased risk of 1-year (RR 4.86) and 3-year (RR 3.35) mortality (P <.05 for both). Conclusion Estimated right atrial pressure> 15, tricuspid regurgitation ≥ moderate, and presence of pericardial effusion are high-risk echocardiographic features in PAH. When seen in combination, these features greatly increase risk of mortality in PAH and may lead to more timely enhanced therapy for patients identified as having an increased risk for death.",
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AU - Burger, Charles Dwayne

AU - Kane, Garvan M

AU - Safford, Robert

AU - Blackshear, Joseph

AU - Ung, Ryan

AU - Ray, Jordan

AU - Alsaad, Ali

AU - Alassas, Khadija

AU - Shapiro, Brian P

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N2 - Aims Echocardiography is the most common imaging modality for assessment of the right ventricle in patients with pulmonary arterial hypertension (PAH). Echocardiographic parameters were identified as independent risk factors for mortality in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) and other PAH cohorts. We sought to identify readily obtained echocardiographic features associated with PAH survival. Methods and results Retrospective analysis of 175 patients with Group 1 was performed. Baseline clinical and laboratory assessment including REVEAL risk criteria were obtained and standard 2-Dimensional and Doppler echocardiography performed at baseline was reviewed. Univariate and multivariate analyses of echocardiographic parameters were performed. Estimated right atrial pressure> 15 mmHg (HR 2.39, P =.02), tricuspid regurgitation ≥ moderate (HR 2.16, P =.04), and presence of pericardial effusion (HR 1.8, P =.05) were identified as independent, high-risk echocardiographic features in PAH. A validation cohort of 677 patients was identified and Kaplan–Meier survival analysis was performed in both cohorts. High-risk echocardiographic features stratified survival curves of both cohorts (P <.01 for all). The presence of 3 high-risk echocardiographic features greatly increased risk of 1-year (RR 4.86) and 3-year (RR 3.35) mortality (P <.05 for both). Conclusion Estimated right atrial pressure> 15, tricuspid regurgitation ≥ moderate, and presence of pericardial effusion are high-risk echocardiographic features in PAH. When seen in combination, these features greatly increase risk of mortality in PAH and may lead to more timely enhanced therapy for patients identified as having an increased risk for death.

AB - Aims Echocardiography is the most common imaging modality for assessment of the right ventricle in patients with pulmonary arterial hypertension (PAH). Echocardiographic parameters were identified as independent risk factors for mortality in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) and other PAH cohorts. We sought to identify readily obtained echocardiographic features associated with PAH survival. Methods and results Retrospective analysis of 175 patients with Group 1 was performed. Baseline clinical and laboratory assessment including REVEAL risk criteria were obtained and standard 2-Dimensional and Doppler echocardiography performed at baseline was reviewed. Univariate and multivariate analyses of echocardiographic parameters were performed. Estimated right atrial pressure> 15 mmHg (HR 2.39, P =.02), tricuspid regurgitation ≥ moderate (HR 2.16, P =.04), and presence of pericardial effusion (HR 1.8, P =.05) were identified as independent, high-risk echocardiographic features in PAH. A validation cohort of 677 patients was identified and Kaplan–Meier survival analysis was performed in both cohorts. High-risk echocardiographic features stratified survival curves of both cohorts (P <.01 for all). The presence of 3 high-risk echocardiographic features greatly increased risk of 1-year (RR 4.86) and 3-year (RR 3.35) mortality (P <.05 for both). Conclusion Estimated right atrial pressure> 15, tricuspid regurgitation ≥ moderate, and presence of pericardial effusion are high-risk echocardiographic features in PAH. When seen in combination, these features greatly increase risk of mortality in PAH and may lead to more timely enhanced therapy for patients identified as having an increased risk for death.

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