Original ArticlesValue of a Doppler-Derived Index Combining Systolic and Diastolic Time Intervals in Predicting Outcome in Primary Pulmonary Hypertension
Section snippets
Methods
The study series was composed of patients with primary pulmonary hypertension diagnosed between January 1987 and December 1994. The diagnosis of primary pulmonary hypertension was based on clinical and hemodynamic criteria.[1]Recurrent thromboembolic pulmonary disease, chronic obstructive pulmonary disease, valvular heart disease, primary intracardiac shunts, or connective tissue disease had previously been excluded. Patients with atrial fibrillation and atrioventricular block were excluded.
Results
The clinical characteristics of the patients (15 men and 38 women, age 45 ± 14 years) and cardiac catheterization data temporally close to the index echocardiography study are listed in Table I. At presentation, the most frequent clinical feature was exertional dyspnea (n = 49, 93%), and most of these patients were in NYHA class III or IV (n = 37, 70%). Less frequent clinical features were ankle swelling (n = 16, 30%), syncope (n = 11, 21%), cyanosis (n = 4, 8%), and ascites (n = 2, 4%).
Discussion
Previous studies have shown that mortality in primary pulmonary hypertension correlates with indexes of RV hemodynamic function obtained invasively.2, 6, 8, 12, 13The development of clinical and hemodynamic evidence of RV dysfunction generally heralds the beginning of an adverse downhill clinical course and poor short-term prognosis. In fact, prognosis of patients with primary pulmonary hypertension in the National Institutes of Health study could be established based on 3 independent
References (28)
Primary pulmonary hypertension
Chest
(1993)- et al.
Primary pulmonary hypertension
Am J Med
(1970) Primary pulmonary hypertension
Prog Cardiovasc Dis
(1988)- et al.
Primary pulmonary hypertensionlength of survival in patients referred for heart-lung transplantation
Chest
(1987) - et al.
Characteristics of surviving and nonsurviving patients with primary pulmonary hypertension
Am J Med
(1984) - et al.
Doppler index combining systolic and diastolic myocardial performanceclinical value in cardiac amyloidosis
J Am Coll Cardiol
(1996) - et al.
Doppler echocardiographic index for assessment of global right ventricular function
J Am Soc Echocardiogr
(1996) - et al.
Quantification of tricuspid regurgitation by Doppler color flow mapping after cardiac transplantation
Am J Cardiol
(1990) - et al.
Simple, rapid method for quantification of tricuspid regurgitation by two dimensional echocardiography
Am J Cardiol
(1989) - et al.
Noninvasive Doppler-derived myocardial performance indexcorrelation with simulataneous measurements of cardiac catheterization measurements
J Am Soc Echocardiogr
(1997)
Primary pulmonary hypertensiona national prospective study
Ann Intern Med
Survival in patients with primary pulmonary hypertensionresults from a national prospective registry
Ann Intern Med
Primary pulmonary hypertensionnatural history and the importance of thrombosis
Circulation
Primary pulmonary hypertensionan analysis of 28 cases and a review of the literature
Medicine
Cited by (470)
Association of delayed diagnosis of pulmonary arterial hypertension with its prognosis
2023, Journal of CardiologyEchocardiographic assessment of ventricular function: Conventional and advanced technologies and their clinical applications
2020, Progress in Pediatric CardiologyThe importance of right ventricular evaluation in risk assessment and therapeutic strategies: Raising the bar in pulmonary arterial hypertension
2020, International Journal of CardiologyEchocardiography Imaging of Cardiotoxicity
2019, Cardiology ClinicsState-of-the-Art Review: Echocardiography in Pulmonary Hypertension
2019, Heart Lung and CirculationCitation Excerpt :The presence of a pericardial effusion has consistently been shown to be associated with poor prognosis in the setting of pulmonary arterial hypertension [24,41,42], except in the setting of Eisenmenger’s syndrome [9,22]. Higher Tei index [43], greater right atrial area [24], larger inferior vena cava (IVC) diameter [44], lower TAPSE [44,45], higher estimated mean and diastolic pulmonary artery pressure [44], the degree of interventricular septal shift [44], right ventricular diameters [46], biventricular index [11] and right ventricular end-systolic remodelling ratio [26] have all been reported to be associated with adverse clinical outcomes in the setting of pulmonary hypertension. Right ventricular systolic to diastolic duration ratio is associated with poor outcome in paediatric pulmonary hypertension [21] and Eisenmenger’s syndrome [22] but has not been studied in broader pulmonary hypertension settings.