Right ventricular wall thickness predicts PH outcomes
medwireNews: Right ventricular relative wall thickness (RV-RWT) is associated with prognosis in patients with pulmonary hypertension (PH), researchers report.
In a retrospective study, Hidekazu Tanaka (Kobe University Graduate School of Medicine, Japan) and colleagues found that among 33 patients with RV-RWT of 0.21 or higher, approximately 90% were alive after a mean 3.1 years of follow-up, compared with approximately 65% of 21 participants with RV-RWT below 0.21 (log rank p=0.03).
PH was defined as resting mean pulmonary artery pressure greater than 25 mmHg. A total of 43% of the 54 participants were diagnosed with chronic thromboembolic PH, whereas 57% had pulmonary arterial hypertension, including idiopathic pulmonary arterial hypertension, connective tissue disease, portopulmonary hypertension, and congenital heart disease. RV-RWT was calculated as RV free-wall thickness/RV basal linear dimension at end-diastole.
In multivariate analysis, RV-RWT was found to be a significant predictor of mid-term RV reverse remodeling (p=0.03), defined as a relative decrease in RV end-systolic area (ΔRVESA) of at least 15% observed during echocardiographic follow-up.
RV remodeling “has been associated with adverse outcomes regardless of the underlying clinical entity, so that assessment of RV remodeling has become increasingly important in the management of PH patients,” the researchers write in The International Journal of Cardiovascular Imaging.
The study participants were divided into four subgroups based on RV-RWT measurements (≥0.21 and <0.21) and the presence or absence of mid-term RV reverse remodeling (ΔRVESA ≥15% and ΔRVESA <15%). The 18 patients with both RV-RWT of 0.21 or higher and mid-term RV reverse remodeling had better overall survival than those in the other subgroups, and survival probability was lowest among 14 patients with RV-RWT lower than 0.21 and without mid-term RV reverse remodeling.
These subgroup analyses indicate that “combining assessment of post-treatment baseline RV-RWT and mid-term RV reverse remodeling may well lead to better clinical management of PH patients compared to individual assessment of either of these predictors alone,” say the study authors.
However, they caution that their investigation was limited by “a small number of patients in a single center retrospective study,” and therefore “future studies involving larger numbers of patient[s] are required to verify our findings.”
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