PMID- 31481176
OWN - NLM
STAT- MEDLINE
DCOM- 20200311
LR  - 20200311
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 124
IP  - 8
DP  - 2019 Oct 15
TI  - Echocardiographic Assessment of Right Ventricular Function and Response to 
      Therapy in Pulmonary Arterial Hypertension.
PG  - 1298-1304
LID - S0002-9149(19)30826-4 [pii]
LID - 10.1016/j.amjcard.2019.07.026 [doi]
AB  - Echocardiography is a key tool in the management of patients with pulmonary 
      arterial hypertension (PAH), but many potential parameters could be used to 
      assess response to therapy. In this retrospective study of 48 patients with 
      severe PAH at baseline, we examined echocardiographic variables before and after 
      initiation of PAH-specific therapy to evaluate which measures of right 
      ventricular (RV) function best correlated with clinical response to therapy as 
      assessed by 6-minute walk distance (6MWD) and 3-year all-cause mortality. 
      Tricuspid annular plane systolic excursion (TAPSE), mid-RV and basal-RV 
      diameters, RV systolic pressure, and RV global longitudinal strain were all found 
      to significantly improve after initiation of a PAH therapy. Decreases in right 
      atrial area (r = -0.50, p = 0.002) and mid-RV diameter (r = -0.36, p = 0.03) were 
      most strongly correlated with improvement in 6MWD. Pretreatment values of RA area 
      (hazard ratio [HR] per 1 SD: 2.72; 95% confidence interval [CI] 1.58, 4.69), 
      mid-RV diameter (HR 2.03; 1.20, 3.45), basal-RV diameter (HR 2.27; 1.40, 3.70), 
      and RV global longitudinal strain (HR 2.36; 1.22, 4.56) were all associated with 
      mortality risk. 6MWD and TAPSE were the 2 variables for which pretreatment 
      measures (6MWD - HR 0.35; 0.17, 0.72; TAPSE - HR 0.41; 0.21, 0.82) and change 
      with treatment (6MWD - HR 0.26; 0.10, 0.64; TAPSE - HR 0.40; 0.21, 0.77) were 
      both significantly associated with 3-year mortality. Change in RV systolic 
      pressure with treatment was significantly associated with mortality (HR 2.55; 
      1.23, 5.28,) but pretreatment baseline had no association (HR 1.48; 0.72, 3.06). 
      Although many echocardiographic parameters change with initiation of PAH 
      treatment, the strong association of both baseline TAPSE and change in TAPSE with 
      mortality supports the ongoing use of TAPSE as an important measure in the 
      assessment of disease severity and treatment response in PAH.
CI  - Copyright (c) 2019 Elsevier Inc. All rights reserved.
FAU - Shelburne, Nicholas J
AU  - Shelburne NJ
AD  - Division of Allergy, Pulmonary and Critical Care Medicine, Department of 
      Medicine, Vanderbilt University Medical Center.
FAU - Parikh, Kishan S
AU  - Parikh KS
AD  - Division of Cardiology, Department of Medicine, Duke University, Durham, North 
      Carolina.
FAU - Chiswell, Karen
AU  - Chiswell K
AD  - Duke Clinical Research Institute, Duke University Medical Center, Durham, North 
      Carolina.
FAU - Shaw, Linda K
AU  - Shaw LK
AD  - Duke Clinical Research Institute, Duke University Medical Center, Durham, North 
      Carolina.
FAU - Sivak, Joseph
AU  - Sivak J
AD  - Division of Cardiology, Department of Medicine, University of North Carolina, 
      Chapel Hill, North Carolina.
FAU - Arges, Kristine
AU  - Arges K
AD  - Department of Medicine, Duke University, Durham, North Carolina.
FAU - Tomfohr, Jennifer
AU  - Tomfohr J
AD  - Department of Medicine, Duke University, Durham, North Carolina.
FAU - Velazquez, Eric J
AU  - Velazquez EJ
AD  - Section of Cardiovascular Medicine, Department of Internal Medicine, Yale 
      University, New Haven, Connecticut.
FAU - Kisslo, Joseph
AU  - Kisslo J
AD  - Division of Cardiology, Department of Medicine, Duke University, Durham, North 
      Carolina.
FAU - Samad, Zainab
AU  - Samad Z
AD  - Division of Cardiology, Department of Medicine, Duke University, Durham, North 
      Carolina.
FAU - Rajagopal, Sudarshan
AU  - Rajagopal S
AD  - Division of Cardiology, Department of Medicine, Duke University, Durham, North 
      Carolina. Electronic address: sudarshan.rajagopal@dm.duke.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190729
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
RN  - 0 (Antihypertensive Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Antihypertensive Agents/*therapeutic use
MH  - Echocardiography/*methods
MH  - Exercise Test
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Ventricles/*diagnostic imaging/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - North Carolina/epidemiology
MH  - Prognosis
MH  - Pulmonary Arterial Hypertension/*drug therapy/mortality/physiopathology
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Stroke Volume/*physiology
MH  - Survival Rate/trends
MH  - Ventricular Function, Right/*physiology
MH  - Young Adult
EDAT- 2019/09/05 06:00
MHDA- 2020/03/12 06:00
CRDT- 2019/09/05 06:00
PHST- 2019/04/22 00:00 [received]
PHST- 2019/07/08 00:00 [revised]
PHST- 2019/07/11 00:00 [accepted]
PHST- 2019/09/05 06:00 [pubmed]
PHST- 2020/03/12 06:00 [medline]
PHST- 2019/09/05 06:00 [entrez]
AID - S0002-9149(19)30826-4 [pii]
AID - 10.1016/j.amjcard.2019.07.026 [doi]
PST - ppublish
SO  - Am J Cardiol. 2019 Oct 15;124(8):1298-1304. doi: 10.1016/j.amjcard.2019.07.026. 
      Epub 2019 Jul 29.