Original Articles
Value of a Doppler-Derived Index Combining Systolic and Diastolic Time Intervals in Predicting Outcome in Primary Pulmonary Hypertension

https://doi.org/10.1016/S0002-9149(98)00140-4Get rights and content

Abstract

Primary pulmonary hypertension is characterized by elevated pulmonary arterial pressure and vascular resistance, frequently producing right heart failure and death. Therefore, the Doppler right ventricular (RV) index, which is a measure of global RV function, could be a useful predictor of outcome in primary pulmonary hypertension. The Doppler RV index, defined as the sum of isovolumic contraction time and isovolumic relaxation time divided by ejection time, was retrospectively measured in 53 patients (38 women, aged 45 ± 14 years) with primary pulmonary hypertension. Ejection time was measured from the pulmonary outflow velocity signal. The sum of isovolumic contraction time and isovolumic relaxation time was obtained by subtracting ejection time from the duration of tricuspid regurgitation. The Doppler RV index tended to be elevated (median 0.83) compared with normal ranges. Normal Doppler RV index was 0.28 ± 0.04. After a mean follow-up duration of 2.9 years, 4 patients underwent lung transplantation and 30 patients died; the cause was cardiac in 28, noncardiac in 1, and uncertain in 1. Univariately, the Doppler RV index (chi-square 20.7, p <0.0001), severity of tricuspid regurgitation (chi-square 8.2, p = 0.004), treatment with calcium blockers (chi-square 6.6, p = 0.01), heart rate (chi-square 5.1, p = 0.02), and symptom status (chi-square 4.9, p = 0.03) were associated with adverse outcome (cardiac deaths and lung transplantation). However, only the Doppler RV index and treatment with calcium blockers were independent predictors within the multivariate model. Our results indicate that the Doppler RV index is a useful predictor of adverse outcome in patients with 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)

  • S Rich et al.

    Primary pulmonary hypertensiona national prospective study

    Ann Intern Med

    (1987)
  • GE D’Alonzo et al.

    Survival in patients with primary pulmonary hypertensionresults from a national prospective registry

    Ann Intern Med

    (1991)
  • V Fuster et al.

    Primary pulmonary hypertensionnatural history and the importance of thrombosis

    Circulation

    (1984)
  • JD Hughes et al.

    Primary pulmonary hypertensionan analysis of 28 cases and a review of the literature

    Medicine

    (1986)
  • Cited by (470)

    • State-of-the-Art Review: Echocardiography in Pulmonary Hypertension

      2019, Heart Lung and Circulation
      Citation 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.

    View all citing articles on Scopus
    View full text