P274Echocardiographic risk stratification in pulmonary arterial hypertensive patients


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Abstract

Purpose: The aim of this study was to create an echocardiographic algorithm for risk stratification following a retrospective analysis of echocardiographic data in pre-capillary pulmonary hypertensive (PH) patients.Methods: All patients referred to the National Pulmonary Hypertension Service of Hammersmith Hospital from 2002 until 2008 were included in the study. The patient cohort was solely focused in all pre-capillary PH patients and consisted of 762 patients. The data was analysed using a time-dependent Cox model. The survival outcome was determined by death. Of 762 patients, 226 (30%) died. Indices that determined survival were inserted into a receiver – operating curve (ROC) analysis in order to identify the optimal cut-off value for predicting mortality at 12 months.Results: When specific cut-off points were determined for each echo parameter, moderate TR (AUC: 0.875) had the greatest sensitivity and specificity to predict 12-month survival, followed by a fractional area contraction (FAC) < 30% (AUC: 0.725). An eccentricity index in end-systole (EIs) > 1.98 (AUC: 0.664), an MPI > 0.84 (AUC: 0.654), presence of PerEf (AUC: 0.623), acceleration time (AT) ≤ 62 msec (AUC: 0.583), right atrial volume (RAvol) > 158 mls (AUC: 0.546), and finally a tricuspid annular plane systolic exertion (TAPSE) ≤ 14 mm (AUC: 0.544) were high risk echocardiographic markers for low survival within 12 months of follow up.Conclusions: In a homogenous group of pre-capillary PH patients, echocardiographic predictors of overall survival were severity of tricuspid regurgitation, MPI, PerEf followed by AT, RAvol and TAPSE. These may risk stratify prospective pulmonary hypertensive patients.

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