Right Ventricular Function Predicts Clinical Response to Specific Vasodilator Therapy in Patients with Pulmonary Hypertension

Authors

  • Sorin Giusca M.D.,

    Corresponding author
    • Cardiology Department, Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu, Bucharest, Romania
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  • Ruxandra Jurcut M.D., Ph.D.,

    1. Cardiology Department, Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu, Bucharest, Romania
    2. University of Medicine and Pharmacy “Carol Davila, Bucharest, Romania
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  • Ioan Mircea Coman M.D., Ph.D.,

    1. Cardiology Department, Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu, Bucharest, Romania
    2. University of Medicine and Pharmacy “Carol Davila, Bucharest, Romania
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  • Ioana Ghiorghiu M.D., Ph.D.,

    1. Cardiology Department, Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu, Bucharest, Romania
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  • Daniela Catrina M.D.,

    1. Cardiology Department, Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu, Bucharest, Romania
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  • Bogdan A. Popescu M.D., Ph.D.,

    1. University of Medicine and Pharmacy “Carol Davila, Bucharest, Romania
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  • Laura Dima M.D.,

    1. Cardiology Department, Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu, Bucharest, Romania
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  • Carmen Ginghina M.D., Ph.D.

    1. Cardiology Department, Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu, Bucharest, Romania
    2. University of Medicine and Pharmacy “Carol Davila, Bucharest, Romania
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  • Sources of Funding: This work was supported by grant ID_246/2008 from the Romanian National Research Programme II.

Address for correspondence and reprint requests: Sorin Giusca, Cardiology Department, Institute for Emergencies in Cardiovascular Diseases “C. C. Iliescu”, Sos. Fundeni 258, Sector 2 022328 Bucuresti, Romania. Fax: 0040213175221; E-mail: soringiusca@gmail.com

Abstract

Introduction: We followed patients with pulmonary arterial hypertension (PAH) receiving specific vasodilator therapy and tested for predictors of clinical outcome. Methods: Thirty-two patients (mean age 39 ± 15 years, 22 women, diagnosed with pulmonary hypertension; PH): 29 with PAH and 3 patients with inoperable chronic thromboembolic PH received therapy with either bosentan, sildenafil, or both and were evaluated with clinical parameters, biomarkers (B-type natriuretic peptide values), and echocardiography before receiving specific medication and every 3 months thereafter. A right heart catheterization was performed at baseline. A composite endpoint of death, worsening of functional class, or the need of a second vasodilator agent was used to define the clinical nonresponders. Results: Patients were followed for 14 months (7.5–21). The endpoint was reached by 15 patients: four patients died (two idiopathic PAH and two PAH in context of Eisenmenger syndrome), seven patients showed 1 functional class worsening, and four patients needed to be switched to combination therapy. Patients who remained clinically stable or improved had at baseline a better cardiac output with a less remodeled right ventricle (RV) and better functioning RV (all P < 0.05). A RV fractional area change (RVFAC) lower than 25.7% and a RV global strain value higher than −13.4% predict with 87% sensitivity and 83% specificity (AUC 87.3%, P = 0.001) and 73% sensitivity and 91% specificity (AUC 84.2%, P = 0.003), respectively, patients who will deteriorate clinically under specific vasodilator therapy. A multivariate model showed RVFAC to be the only independent predictor of the endpoint with a HR of 0.87 (0.8–0.96), P = 0.007. Conclusions: Over an average period of 1 year, almost half of patients showed signs of clinical deterioration despite specific vasodilator therapy. Parameters of right ventricular morphology and function had prognostic value in these patients.

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