Risk of death and need for transplantation in chronic pulmonary hypertension

Echo-Doppler parameters that exemplify right ventricular (RV) outflow dynamics and measures of annular tissue Doppler imaging to assess left ventricular (LV) and RV diastolic function, known to be affected in chronic pulmonary hypertension (cPH), have never been studied to determine if they could be predictive of mortality or need for transplantation 1-year after follow-up.

Numerous echo-Doppler parameters of RV and LV performance were recorded from 120 patients. This patient population was divided into 3 groups. Group I had no PH, group II had cPH but no documented death or need for either lung or heart transplantation, at 1-year follow-up after their initial echocardiogram whereas group III had cPH and patients had either died or required heart and/or lung transplantation during the same time period.

Analysis of variance was first used to identify which echo-Doppler variables were significant among the studied groups. A logistic regression analysis was then performed to identify predictive variables of the occurrence death and need for transplantation. Finally, a multiple regression analysis was used between groups II and III to identify which echo-Doppler variables were most useful in identifying severe cPH patients at risk of the prespecified events.

Even though older patients with worse RV fractional area change might be considered at risk of worse prognosis in patients with severe cPH, only a low mitral annular early diastolic velocity was useful in identifying which of those individuals were at highest risk of death or in need of transplantation.