Right ventricular relative wall thickness as a predictor of outcomes and of right ventricular reverse remodeling for patients with pulmonary hypertension.

Abstract

Mid-term right ventricular (RV) reverse remodeling after treatment in patients with pulmonary hypertension (PH) is associated with long-term outcome as well as baseline RV remodeling. However, baseline factors influencing mid-term RV reverse remodeling after treatment and its prognostic capability remain unclear. We studied 54 PH patients. Mid-term RV remodeling was assessed in terms of the RV area, which was traced planimetrically at the end-systole (RVESA). RV reverse remodeling was defined as a relative decrease in the RVESA of at least 15% at 10.2 ± 9.4 months after treatment. Long-term follow-up was 5 years. Adverse events occurred in ten patients (19%) and mid-term RV reverse remodeling after treatment was observed in 37 (69%). Patients with mid-term RV reverse remodeling had more favorable long-term outcomes than those without (log-rank: p = 0.01). Multivariate logistic regression analysis showed that RV relative wall thickness (RV-RWT), as calculated as RV free-wall thickness/RV basal linear dimension at end-diastole, was an independent predictor of mid-term RV reverse remodeling (OR 1.334; 95% CI, 1.039-1.713; p = 0.03). Moreover, patients with RV-RWT ≥0.21 showed better long-term outcomes than did those without (log-rank p = 0.03), while those with RV-RWT ≥0.21 and mid-term RV reverse remodeling had the best long-term outcomes. Patients with RV-RWT <0.21 and without mid-term RV reverse remodeling, on the other hand, had worse long-term outcomes than other sub-groups. In conclusions, RV-RWT could predict mid-term RV reverse remodeling after treatment in PH patients, and was associated with long-term outcomes. Our finding may have clinical implications for better management of PH patients.

• Authors: Hiroyuki Sano, Hidekazu Tanaka, Yoshiki Motoji, Yuko Fukuda, Yasuhide Mochizuki, Yutaka Hatani, Hiroki Matsuzoe, Keiko Hatazawa, Hiroyuki Shimoura, Junichi Ooka, Keiko Ryo-Koriyama, Kazuhiko Nakayama, Kensuke Matsumoto, Noriaki Emoto, Ken-Ichi Hirata
• Journal: The international journal of cardiovascular imaging (Int J Cardiovasc Imaging) Vol. 33 Issue 3 Pg. 313-321 (Mar 2017) ISSN: 1875-8312 [Electronic] United States
• PMID: 27783186 (Publication Type: Journal Article)

Chemical References

• Antihypertensive Agents

Topics

• Aged
• Antihypertensive Agents (therapeutic use)
• Area Under Curve
• Chi-Square Distribution
• Disease-Free Survival
• Echocardiography, Doppler
• Female
• Humans
• Hypertension, Pulmonary (complications, diagnostic imaging, drug therapy, physiopathology)
• Hypertrophy, Right Ventricular (diagnostic imaging, etiology, physiopathology)
• Kaplan-Meier Estimate
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Odds Ratio
• Predictive Value of Tests
• Proportional Hazards Models
• ROC Curve
• Recovery of Function
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• Ventricular Dysfunction, Right (diagnostic imaging, etiology, physiopathology)
• Ventricular Function, Right (drug effects)
• Ventricular Remodeling (drug effects)