European Heart Journal Advance Access originally published online on January 22, 2007
European Heart Journal 2007 28(10):1250-1257; doi:10.1093/eurheartj/ehl477
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Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension
1 Department of Pulmonary Diseases, Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
2 Department of Physics and Medical Technology, Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
3 Department of Cardiology, Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
4 Clinical Epidemiology and Biostatistics, Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
Received 19 June 2006; revised 11 December 2006; accepted 21 December 2006; online publish-ahead-of-print 22 January 2007.
* Corresponding author. Tel: ±31 20 4444728; fax: ±31 20 4444382. E-mail address: a.vonk{at}vumc.nl
See page 1187 for the editorial comment on this article (doi:10.1093/eurheartj/ehm074)
Aims: This study investigated the relationship between right ventricular (RV) structure and function and survival in idiopathic pulmonary arterial hypertension (IPAH).
Methods and results: In 64 patients, cardiac magnetic resonance, right heart catheterization, and the six-minute walk test (6MWT) were performed at baseline and after 1-year follow-up. RV structure and function were analysed as predictors of mortality. During a mean follow-up of 32 months, 19 patients died. A low stroke volume (SV), RV dilatation, and impaired left ventricular (LV) filling independently predicted mortality. In addition, a further decrease in SV, progressive RV dilatation, and further decrease in LV end-diastolic volume (LVEDV) at 1-year follow-up were the strongest predictors of mortality. According to KaplanMeier survival curves, survival was lower in patients with an inframedian SV index
25 mL/m2, a supramedian RV end-diastolic volume index
84 mL/m2, and an inframedian LVEDV
40 mL/m2.
Conclusions: The RV contains prognostic information in IPAH. A large RV volume, low SV, and a reduced LV volume are strong independent predictors of mortality and treatment failure.
Key Words: Pulmonary hypertension Prognosis Magnetic resonance imaging Right ventricle
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