Tricuspid annular displacement predicts survival in pulmonary hypertension

被引:776
作者
Forfia, Paul R.
Fisher, Micah R.
Mathai, Stephen C.
Housten-Harris, Traci
Hemnes, Anna R.
Borlaug, Barry A.
Chamera, Elzbieta
Corretti, Mary C.
Champion, Hunter C.
Abraham, Theodore P.
Girgis, Reda E.
Hassoun, Paul M.
机构
[1] Johns Hopkins Univ Hosp, Div Pulm & Crit Care Med, Ctr Asthma & Allergy, Dept Med, Baltimore, MD 21224 USA
[2] Johns Hopkins Univ Hosp, Div Cardiol, Baltimore, MD 21224 USA
关键词
prognosis; pulmonary arterial hypertension; right ventricular function; tricuspid annular displacement; TAPSE;
D O I
10.1164/rccm.200604-547OC
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Rationale: Right ventricular (RV) function is an important determinant of prognosis in pulmonary hypertension. However, noninvasive assessment of the RV function is often limited by complex geometry and poor endocardial definition. Objectives:To test whether the degree of tricuspid annular displacement (tricuspid annular plane systolic excursion [TAPSE]) is a useful echo-derived measure of RV function with prognostic significance in pulmonary hypertension. Methods: We prospectively studied 63 consecutive patients with pulmonary hypertension who were referred for a clinically indicated right heart catheterization. Patients underwent right heart catheterization immediately followed by transthoracic echocardiogram and TAPSE measurement. Results: In the overall cohort, a TAPSE of less than 1.8 cm was associated with greater RV systolic dysfunction (cardiac index, 1.9 vs. 2.7 L/min/m(2); RV % area change, 24 vs. 33%), right heart remodeling (right atrial area index, 17.0 vs. 12.1 cm(2)/m), and RV-Ieft ventricular (LV) disproportion (RV/LV diastolic area, 1.7 vs. 1.2; all p < 0.001), versus a TAPSE of 1.8 cm or greater. In patients with pulmonary arterial hypertension (PAH; n = 47), survival estimates at 1 and 2 yr were 94 and 88%, respectively, in those with a TAPSE of 1.8 cm or greater versus 60 and 50%, respectively, in subjects with a TAPSE less than 1.8 cm. The unadjusted risk of death (hazard ratio) in patients with a TAPSE less than 1.8 versus 1.8 cm or greater was 5.7 (95% confidence interval, 1.3-24.9; p = 0.02) for the PAH cohort. For every 1-mm decrease in TAPSE, the unadjusted risk of death increased by 17% (hazard ratio, 1.17; 95% confidence interval, 1.05-1.30; p = 0.006), which persisted after adjusting for other echocardiographic and hemodynamic variables and baseline treatment status. Conclusions: TAPSE powerfully reflects RV function and prognosis in PAH.
引用
收藏
页码:1034 / 1041
页数:8
相关论文
共 28 条
[1]   Longitudinal motion of the atrioventricular annuli in children: Reference values, growth related changes, and effects of right ventricular volume and pressure overload [J].
Arce, OX ;
Knudson, OA ;
Ellison, MC ;
Baselga, P ;
Ivy, DD ;
DeGroff, C ;
Valdes-Cruz, L .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2002, 15 (09) :906-916
[2]   The right ventricle in pulmonary hypertension [J].
Chin, KM ;
Kim, NHS ;
Rubin, LJ .
CORONARY ARTERY DISEASE, 2005, 16 (01) :13-18
[3]  
COX DR, 1972, J R STAT SOC B, V34, P187
[4]   SURVIVAL IN PATIENTS WITH PRIMARY PULMONARY-HYPERTENSION - RESULTS FROM A NATIONAL PROSPECTIVE REGISTRY [J].
DALONZO, GE ;
BARST, RJ ;
AYRES, SM ;
BERGOFSKY, EH ;
BRUNDAGE, BH ;
DETRE, KM ;
FISHMAN, AP ;
GOLDRING, RM ;
GROVES, BM ;
KERNIS, JT ;
LEVY, PS ;
PIETRA, GG ;
REID, LM ;
REEVES, JT ;
RICH, S ;
VREIM, CE ;
WILLIAMS, GW ;
WU, M .
ANNALS OF INTERNAL MEDICINE, 1991, 115 (05) :343-349
[5]   Noninvasive Doppler tissue measurement of pulmonary artery compliance in children with pulmonary hypertension [J].
Dyer, K ;
Lanning, C ;
Das, B ;
Lee, PF ;
Ivy, DD ;
Valdes-Cruz, L ;
Shandas, R .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2006, 19 (04) :403-412
[6]   Use of myocardial performance index in pediatric patients with idiopathic pulmonary arterial hypertension [J].
Dyer, Karrie L. ;
Pauliks, Linda B. ;
Das, Bibhuti ;
Shandas, Robin ;
Ivy, Dunbar ;
Shaffer, Elizabeth M. ;
Valdes-Cruz, Lilliam M. .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2006, 19 (01) :21-27
[7]   Mechanisms of disease: Pulmonary arterial hypertension [J].
Farber, HW ;
Loscalzo, J .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 351 (16) :1655-1665
[8]  
FORFIA PR, 2006, P AM THORAC SOC, V3, pA60
[9]   Effects of the oral endothelin-receptor antagonist bosentan on echocardiographic and Doppler measures in patients with pulmonary arterial hypertension [J].
Galiè, N ;
Hinderliter, AL ;
Torbicki, A ;
Fourme, T ;
Simonneau, G ;
Pulido, T ;
Espinola-Zavaleta, N ;
Rocchi, G ;
Manes, A ;
Frantz, R ;
Kurzyna, M ;
Nagueh, SF ;
Barst, R ;
Channick, R ;
Dujardin, K ;
Kronenberg, A ;
Leconte, I ;
Rainisio, M ;
Rubin, L .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (08) :1380-1386
[10]   Impaired left ventricular filling due to right-to-left ventricular interaction in patients with pulmonary arterial hypertension [J].
Gan, CTJ ;
Lankhaar, JW ;
Marcus, JT ;
Westerhof, N ;
Marques, KM ;
Bronzwaer, JGF ;
Boonstra, A ;
Postmus, PE ;
Vonk-Noordegraaf, A .
AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY, 2006, 290 (04) :H1528-H1533