PT - JOURNAL ARTICLE AU - Rebecca R Vanderpool AU - Michael R Pinsky AU - Robert Naeije AU - Christopher Deible AU - Vijaya Kosaraju AU - Cheryl Bunner AU - Michael A Mathier AU - Joan Lacomis AU - Hunter C Champion AU - Marc A Simon TI - RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension AID - 10.1136/heartjnl-2014-306142 DP - 2015 Jan 01 TA - Heart PG - 37--43 VI - 101 IP - 1 4099 - http://heart.bmj.com/content/101/1/37.short 4100 - http://heart.bmj.com/content/101/1/37.full SO - Heart2015 Jan 01; 101 AB - Objective Prognosis in pulmonary hypertension (PH) is largely determined by RV function. However, uncertainty remains about what metrics of RV function might be most clinically relevant. The purpose of this study was to assess the clinical relevance of metrics of RV functional adaptation to increased afterload. Methods Patients referred for PH underwent right heart catheterisation and RV volumetric assessment within 48 h. A RV maximum pressure (Pmax) was calculated from the RV pressure curve. The adequacy of RV systolic functional adaptation to increased afterload was estimated either by a stroke volume (SV)/end-systolic volume (ESV) ratio, a Pmax/mean pulmonary artery pressure (mPAP) ratio, or by EF (RVEF). Diastolic function of the RV was estimated by a diastolic elastance coefficient β. Survival analysis was via Cox proportional HR, and Kaplan–Meier with the primary outcome of time to death or lung transplant. Results Patients (n=50; age 58±13 yrs) covered a range of mPAP (13–79 mm Hg) with an average RVEF of 39±17% and ESV of 143±89 mL. Average estimates of the ratio of end-systolic ventricular to arterial elastance were 0.79±0.67 (SV/ESV) and 2.3±0.65 (Pmax/mPAP-1). Transplantation-free survival was predicted by right atrial pressure, mPAP, pulmonary vascular resistance, β, SV, ESV, SV/ESV and RVEF, but after controlling for right atrial pressure, mPAP, and SV, SV/ESV was the only independent predictor. Conclusions The adequacy of RV functional adaptation to afterload predicts survival in patients referred for PH. Whether this can simply be evaluated using RV volumetric imaging will require additional confirmation.