P731The relationship between the right ventricular hemodynamic parameters with clinical and echocardiographic prognostic parameters in patients with pulmonary arterial hypertension

Abstract

Background and aim: Pulmonary arterial hypertension (PAH) is a progressive disease of the pulmonary vasculature leads to right ventricular (RV) failure and death. Prognostic indicators are known to have an important value in guiding the treatment of PAH which is associated with high mortality and morbidity. Right heart catheterization (RHC) is still considered as the standard for the diagnosis, according to the guidelines. The aim of this study was to evaluate the relationship between new hemodynamic parameters obtained during RHC and conventional RV prognostic clinical and echocardiographic parameters Methods: We evaluated 187 consecutive patients (age: 50+/-15 years)with the diagnosis of pulmonary hypertension confirmed with RHC between 2009 and 2014. Standard Fick method was used for the hemodynamic measurement and calculations including cardiac output (CO), cardiac index, pulmonary vascular resistance (PVR), pulmonary arterial compliance (PAC), pulmonary arterial elastance (PAE), pulmonary artery pulsatility index (PAPi), pulmonary artery pulse pressure (PAPP), RV stroke work index (RSWI) and the ratio of right atrium mean pressure (RA) to pulmonary capillary wedge pressure (PCWP). Correlation analyses were performed between RHC parameters, clinical parameters [functional class (FC), 6-minute walking distance, NT-proBNP] and echocardiographic parameters (RVEF, RVed, TDI RVsm, TAPSE, TRV). Result(s): Correlation analysis revealed that, PAE was significantly correlated with FC (r:0.31,p:0.001), TAPSE (r:-0.31, p:0.001), and RVsm (r:-0.31,p:0.002). PAC was significantly associated with FC (r:-0.26, p=0.006) and RVsm (r:-0.47, p:0.001). RSWI was only significantly correlated with FC (r:0.262, p:0.006). PAP was significantly correlated with RVsm (r:-0.36, p:0.005). RA, RA/PCWP and PAPi did not reveal any correlation. Subgroup analysis of patients with atrial fibrillation (n=30) did not reveal any of the mentioned correlations of new hemodynamic parameters Conclusion(s): PAE, PAC, RSWI and PAPP are applicative new hemodynamic parameters to reveal RV dysfunction in patients with PH. However, presence of atrial fibrillation leads to the loss of associations between these parameters and conventional prognostic markers.