Clinical determinants and prognostic implications of right ventricular dysfunction in pulmonary hypertension caused by chronic lung disease

Kurt W Prins, Lauren Rose, Stephen L. Archer, Marc R Pritzker, Edward K Weir, Matthew D. Olson, Thenappan Thenappan

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background Patients with pulmonary hypertension caused by chronic lung disease (Group 3 PH) have disproportionate right ventricle (RV) dysfunction, but the correlates and clinical implications of RVdysfunction in Group 3 PH are not well defined. Methods and Results We performed a cohort study of 147 Group 3 PH patients evaluated at the University of Minnesota. RV systolic function was quantified using right ventricular fractional area change (RVFAC) and + dP/dt max /instantaneous pressure. Tau and RV diastolic stiffness characterized RV diastolic function. Multivariate linear regression was used to define correlates of RVFAC. Kaplan‐Meier and Cox proportional hazards analyses were used to examine freedom from heart failure hospitalization and death. Positive correlates of RVFAC on univariate analysis were pulmonary arterial compliance, cardiac index, and left ventricular diastolic dimension. Conversely, male sex, N‐terminal pro‐brain natriuretic peptide, heart rate, right atrial enlargement, mean pulmonary arterial pressure, and pulmonary vascular resistance were negative correlates. Male sex was the strongest predictor of lower RVFAC, after adjusting for pulmonary vascular resistance and pulmonary arterial compliance. When comparing sexes, males had lower RVFAC (26% versus 31%, P=0.03) both overall and for any given mean pulmonary arterial pressure and pulmonary vascular resistance value. Males exhibited a reduction in + dP/dt max /instantaneous pressure as pulmonary vascular resistance increased, whereas females did not. There were no sex differences in RV diastolic function. RV dysfunction (RVFAC<28%) was associated with increased risk of heart failure hospitalization or death (hazard ratio: 1.84, 95% CI: 1.04–3.10, P=0.035). Conclusions Male sex is associated with RV dysfunction in Group 3 PH, even after adjusting for RV afterload. RV dysfunction (RVFAC <28%) identifies Group 3 PH patients at risk for poor outcomes.

Original languageEnglish (US)
Article numbere011464
JournalJournal of the American Heart Association
Volume8
Issue number2
DOIs
StatePublished - Jan 1 2019

Bibliographical note

Funding Information:
Prins is funded by NIH K08 HL140100, Archer is supported by Canada Foundation for Innovation (229252 and 33012), NIH RO1 HL113003, a Tier 1 Canada Research Chair in Mitochondrial Dynamics and Translational Medicine (950-229252), the Queens Cardiopulmonary Unit (QCPU), and a grant from the William J Henderson Foundation. Thenappan is funded by American Heart Association Scientist Development Grant 15SDG25560048.

Funding Information:
Prins is funded by NIH K08 HL140100, Archer is supported by Canada Foundation for Innovation (229252 and 33012), NIH RO1 HL113003, a Tier 1 Canada Research Chair in Mitochondrial Dynamics and Translational Medicine (950‐229252), the Queens Cardiopulmonary Unit (QCPU), and a grant from the William J Henderson Foundation. Thenappan is funded by American Heart Association Scientist Development Grant 15SDG25560048.

Keywords

  • Coronary artery bypass graft surgery
  • Coronary artery disease
  • Diabetes mellitus
  • Percutaneous coronary intervention
  • Plasminogen activator inhibitor-1
  • Tissue plasminogen activator
  • Type 2 diabetes mellitus

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