Non-invasive right ventricular load adaptability indices in patients with scleroderma-associated pulmonary arterial hypertension
Scleroderma-associated pulmonary arterial hypertension (SSc-PAH) is associated with worse outcome than idiopathic pulmonary arterial hypertension (IPAH), potentially due to worse right ventricular adaptation to load as suggested by pressure–volume loop analysis. The value of non-invasive load-adapta...
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doaj-1680e998d79f4b0380bfc07bb00457e22020-11-25T03:42:15ZengSAGE PublishingPulmonary Circulation2045-89402018-07-01810.1177/2045894018788268Non-invasive right ventricular load adaptability indices in patients with scleroderma-associated pulmonary arterial hypertensionSarah French0Myriam Amsallem1Nadia Ouazani2Shufeng Li3Kristina Kudelko4Roham T. Zamanian5Francois Haddad6Lorinda Chung7Division of Internal Medicine, Stanford University Medical Center, USAResearch and Innovation Unit, INSERM U999, DHU Torino, Paris Sud University, Marie Lannelongue Hospital, FranceDivision of Cardiovascular Medicine, Stanford University Medical Center, USADivision of Biostatistics, Stanford University Medical Center, USADivision of Pulmonary and Critical Care Disease, Stanford University Medical Center, USAVera Moulton Wall Center for Pulmonary Hypertension at Stanford, Palo Alto, USADivision of Cardiovascular Medicine, Stanford University Medical Center, USADivision of Rheumatology, Palo Alto VA Healthcare System, Palo Alto, USAScleroderma-associated pulmonary arterial hypertension (SSc-PAH) is associated with worse outcome than idiopathic pulmonary arterial hypertension (IPAH), potentially due to worse right ventricular adaptation to load as suggested by pressure–volume loop analysis. The value of non-invasive load-adaptability metrics has not been fully explored in SSc-PAH. This study sought to assess whether patients with incident SSc-PAH have worse echocardiographic load-adaptability metrics than patients with IPAH. Twenty-two patients with incident SSc-PAH were matched 1:1 with IPAH based on pulmonary vascular resistance. Echocardiographic load-adaptability indices were divided into: surrogates of ventriculo-arterial coupling (e.g. right ventricular area change/end-systolic area), indices reflecting the proportionality of load adaptation (e.g. tricuspid regurgitation velocity-time integral normalized for average right ventricular radius), and simple ratios (e.g. tricuspid annular plane systolic excursion/right ventricular systolic pressure). The prognostic value of these indices for clinical worsening (i.e. death, transplant, or hospitalization for heart failure) at one year was explored. The two groups were comprised of patients of similar age, with similar cardiac index, pulmonary resistance, capacitance and NT-proBNP levels ( p > 0.10). There was no difference in baseline right ventricular dimension, function or load-adaptability indices. At one year, eight (36.4%) SSc-PAH patients had experienced clinical worsening (eight hospitalizations and two deaths) versus one hospitalization in the IPAH group. Load adaptation at one year in survivors was not worse in SSc-PAH ( p > 0.33). Patients with IPAH responded better to therapy than SSc-PAH in terms of reduction of right ventricular areas at one year ( p < 0.05). Right ventricular load-adaptability echocardiographic indices do not appear to capture the increased risk of negative outcomes at one year associated with SSc-PAH.https://doi.org/10.1177/2045894018788268 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sarah French Myriam Amsallem Nadia Ouazani Shufeng Li Kristina Kudelko Roham T. Zamanian Francois Haddad Lorinda Chung |
spellingShingle |
Sarah French Myriam Amsallem Nadia Ouazani Shufeng Li Kristina Kudelko Roham T. Zamanian Francois Haddad Lorinda Chung Non-invasive right ventricular load adaptability indices in patients with scleroderma-associated pulmonary arterial hypertension Pulmonary Circulation |
author_facet |
Sarah French Myriam Amsallem Nadia Ouazani Shufeng Li Kristina Kudelko Roham T. Zamanian Francois Haddad Lorinda Chung |
author_sort |
Sarah French |
title |
Non-invasive right ventricular load adaptability indices in patients with scleroderma-associated pulmonary arterial hypertension |
title_short |
Non-invasive right ventricular load adaptability indices in patients with scleroderma-associated pulmonary arterial hypertension |
title_full |
Non-invasive right ventricular load adaptability indices in patients with scleroderma-associated pulmonary arterial hypertension |
title_fullStr |
Non-invasive right ventricular load adaptability indices in patients with scleroderma-associated pulmonary arterial hypertension |
title_full_unstemmed |
Non-invasive right ventricular load adaptability indices in patients with scleroderma-associated pulmonary arterial hypertension |
title_sort |
non-invasive right ventricular load adaptability indices in patients with scleroderma-associated pulmonary arterial hypertension |
publisher |
SAGE Publishing |
series |
Pulmonary Circulation |
issn |
2045-8940 |
publishDate |
2018-07-01 |
description |
Scleroderma-associated pulmonary arterial hypertension (SSc-PAH) is associated with worse outcome than idiopathic pulmonary arterial hypertension (IPAH), potentially due to worse right ventricular adaptation to load as suggested by pressure–volume loop analysis. The value of non-invasive load-adaptability metrics has not been fully explored in SSc-PAH. This study sought to assess whether patients with incident SSc-PAH have worse echocardiographic load-adaptability metrics than patients with IPAH. Twenty-two patients with incident SSc-PAH were matched 1:1 with IPAH based on pulmonary vascular resistance. Echocardiographic load-adaptability indices were divided into: surrogates of ventriculo-arterial coupling (e.g. right ventricular area change/end-systolic area), indices reflecting the proportionality of load adaptation (e.g. tricuspid regurgitation velocity-time integral normalized for average right ventricular radius), and simple ratios (e.g. tricuspid annular plane systolic excursion/right ventricular systolic pressure). The prognostic value of these indices for clinical worsening (i.e. death, transplant, or hospitalization for heart failure) at one year was explored. The two groups were comprised of patients of similar age, with similar cardiac index, pulmonary resistance, capacitance and NT-proBNP levels ( p > 0.10). There was no difference in baseline right ventricular dimension, function or load-adaptability indices. At one year, eight (36.4%) SSc-PAH patients had experienced clinical worsening (eight hospitalizations and two deaths) versus one hospitalization in the IPAH group. Load adaptation at one year in survivors was not worse in SSc-PAH ( p > 0.33). Patients with IPAH responded better to therapy than SSc-PAH in terms of reduction of right ventricular areas at one year ( p < 0.05). Right ventricular load-adaptability echocardiographic indices do not appear to capture the increased risk of negative outcomes at one year associated with SSc-PAH. |
url |
https://doi.org/10.1177/2045894018788268 |
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