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