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Right ventricular end-systolic remodelling index predicts outcomes in pulmonary arterial hypertension

12 Jul 2017
Donors' organs are distributed based on clinical criteria, such as waiting times, and suitability between donors and recipients.

The right ventricular end-systolic remodelling index (RVESRI) is a simple and good prognostic marker of outcomes in patients with pulmonary arterial hypertension, a new study shows.

Univariate analysis revealed that New York Heart Association class (NYHA; hazard ratio [HR], 3.36; 95 percent CI, 2.10 to 5.38; p<0.001), serum levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP; HR, 1.95; 1.57 to 2.42; p<0.001), right ventricular free wall longitudinal strain (RVLS; HR, 0.63; 0.51 to 0.82; p<0.001) and RVESRI (HR, 2.05; 1.66 to 2.53; p<0.001) were all significantly associated with death, transplant or admission.

After multivariate analysis, only NYHA class (HR, 1.96; 1.14 to 3.37; p=0.01), NT-proBNP levels (HR, 1.32; 1.01 to 1.73; p=0.04) and RVESRI (HR, 1.58; 1.22 to 2.04; p=0.001) remained significant predictors of the primary endpoint of death, lung transplant or admission for heart failure.

A comparison of other indices of RV end-systolic size or transverse-to-longitudinal ratio showed that RVESRI (χ2, 62; p<0.0001) was more accurately associated with the outcome than RV end-systolic area (RVESA)/height (χ2, 52; p<0.0001), RVESA/body surface area (χ2, 48; p<0.0001) and other indices.

The final model for the primary endpoint included NYHA class, RVESRI and NT-proBNP levels (χ2, 62.2; p<0.0001). The final model for the secondary endpoint of death or lung transplant included RVESRI and NT-proBNP levels (χ2, 42.40; p<0.0001).

The study included 228 pulmonary arterial hypertension patients (mean age 49±14 years; 78 percent female). RVESRI was calculated by dividing the lateral length by the septal height, both measured from echocardiographs.

Over a mean follow-up of 3.9±2.4 years, 43 deaths, 15 transplants and 30 admissions were reported, yielding a total of 88 events for the primary endpoint and 58 for the secondary endpoint.

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Most Read Articles
5 days ago
Higher circulating levels of docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA) appear to be protective against incident atherothrombotic and cardioembolic strokes, respectively, according to a recent study.
Roshini Claire Anthony, 11 Oct 2017

The prevalence of resistant hypertension may be lower than expected, particularly once pseudo-resistant hypertension due to treatment nonadherence is taken into account, according to a presentation at the recent APCH 2017.

Pank Jit Sin, 07 Jan 2015

Cardiovascular diseases (CVD) have been the main cause of death in the Malaysian population since 2007. This trend has continued, with the number of people dying from CVD-related causes increasing year on year. 

Tristan Manalac, 12 Oct 2017
Administration of a long-acting medication at the time that is most suitable for maximum patient compliance is the best approach in controlling blood pressure, said Dr. Trefor Morgan at the recently concluded 13th Asian-Pacific Congress of Hypertension (APCH 2017), held at the Suntec Singapore Convention and Exhibition Centre.