Association Between Right Ventricular Contractile Function and Cardiac Events in Isolated Postcapillary and Combined Pre- and Postcapillary Pulmonary Hypertension

Background: Recent studies showed that the combined pre- and post-capillary pulmonary hypertension (CpcPH) had worse outcomes compared with isolated post-capillary (Ipc) PH. However, the prognostic factors including right ventricular (RV) function have not been well documented. The aim of this study was to assess the differentiation of PH phenotypes using echocardiography, and the association between RV longitudinal strain and cardiac events.
Methods and Results: We prospectively recruited consecutive patients who had undergone right heart catheterization. The primary endpoint was cardiovascular death or readmission due to heart failure. One hundred thirty-seven patients with Group 2 PH were included. A RV longitudinal strain of 17% was sensitive (85%) and specific (70%) to determine the CpcPH. During a median period of 31 months, 43 patients had the primary endpoint during follow-up. In a multivariate analysis, RV longitudinal strain was associated with the primary endpoint in both CpcPH and IpcPH (hazard ratio: HR: 0.84, p =0.003 and HR: 0.86, p =0.001).
Conclusions: Lower RV longitudinal strain was independently associated with worse outcomes in CpcPH and IpcPH. RV longitudinal strain may play a prognostic role among PH phenotypes.

© 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/