Role of Echocardiogram in Predicting Prognosis in Pulmonary Arterial Hypertension: A Meta-Analysis

Kanwar, Manreet; Khan, Muhammad Shahzeb; Raina, Amresh; Badagliacca, Roberto; Antaki, James F.; Amin, Emaan; Benza, Raymond L.

doi:10.1016/j.healun.2020.01.121

Cited by 4 publications

(1 citation statement)

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“…Studies showed that stable patients with reassuring WHO FC and 6MWD at follow-up develop a progressive deterioration of RV EF and dimensions [23]. Indeed, echo-derived morpho-dimensional and ejection phase parameters have been analyzed in PAH studies, all proving their prognostic relevance [24][25][26][27][28][29]. RA size measurements give indirect information on RV function and have prognostic value [30,31].…”

Section: Echocardiographic Parameters With Prognostic Impact (Echocarmentioning

confidence: 99%

The Growing Role of Echocardiography in Pulmonary Arterial Hypertension Risk Stratification: The Missing Piece

Miotti

Papa

Manzi

et al. 2021

JCM

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Pulmonary arterial hypertension (PAH) is a rare, progressive disease with a poor prognosis. The pathophysiologic model is mainly characterized by an afterload mismatch in which an increased right ventricle afterload, driven by increased pulmonary vascular resistance (PVR), leads to right heart failure. International guidelines recommend optimization of treatment based on regular risk assessments to achieve or maintain a low-risk status. Current risk scores are based on a multi-modality approach, including demographic, clinical, functional, exercise, laboratory, and hemodynamic parameters, which lack significant echocardiographic parameters. The originality of echocardiography relies on the opportunity to assess in a non-invasive way a physiologically meaningful combination of easy to measure variables tightly related to right ventricle adaptation/maladaptation to increased afterload, the main determinant of a patient’s prognosis. Echo-derived morphological and functional parameters have been investigated in PAH, proving to have prognostic relevance. Different therapeutic strategies proved to have different effects in reducing PVR. An upfront combination of drugs, including a parenteral prostacyclin, has shown to be associated with right heart reverse remodeling in a greater proportion of patients than other treatment strategies as a function of PVR reduction. Adding echocardiographic data to current risk scores would allow better identification of right ventricle (RV) adaptation in PAH patients’ follow-up. This additional information would allow better stratification of the patient, leading to optimized and personalized therapeutic management.

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Section: Echocardiographic Parameters With Prognostic Impact (Echocarmentioning

confidence: 99%

The Growing Role of Echocardiography in Pulmonary Arterial Hypertension Risk Stratification: The Missing Piece

Miotti

Papa

Manzi

et al. 2021

JCM

View full text Add to dashboard Cite

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Risk stratification and treatment goals in pulmonary arterial hypertension

Dardi,

Boucly,

Benza

et al. 2024

Eur Respir J

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Risk stratification has gained an increasing role in predicting outcomes and guiding the treatment of patients with pulmonary arterial hypertension (PAH). The most predictive prognostic factors are three noninvasive parameters (World Health Organization functional class, 6-min walk distance and natriuretic peptides) that are included in all currently validated risk stratification tools. However, suffering from limitations mainly related to reduced specificity of PAH severity, these variables may not always be adequate in isolation for guiding individualised treatment decisions. Moreover, with effective combination treatment regimens and emerging PAH therapies, markers associated with pulmonary vascular remodelling are expected to become of increasing relevance in guiding the treatment of patients with PAH. While reaching a low mortality risk, assessed with a validated risk tool, remains an important treatment goal, preliminary data suggest that invasive haemodynamics and cardiac imaging may add incremental value in guiding treatment decisions.

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Predicting high-risk pre-capillary pulmonary hypertension: an echocardiographic multiparameter scoring index

Zhai,

Li,

Tao

et al. 2024

BMC Cardiovasc Disord

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Background The risk stratification of pulmonary arterial hypertension proposed by the European Society of Cardiology /European Respiratory Society guidelines in 2015 and 2022 included two to three echocardiographic indicators. However, the specific value of echocardiography in risk stratification of pre-capillary pulmonary hypertension (pcPH) has not been efficiently demonstrated. Given the complex geometry of the right ventricular (RV) and influencing factors of echocardiographic parameter, there is no single echocardiographic parameter that reliably informs about PH status. We hypothesize that a multi-parameter comprehensive index can more accurately evaluate the severity of the pcPH. The purpose of this study was to develop and validate an echocardiographic risk score model to better assist clinical identifying high risk of pcPH during initial diagnosis and follow-up. Methods We studied 197 consecutive patients with pcPH. A multivariable echocardiographic model was constructed to predict the high risk of pcPH in the training set. Points were assigned to significant risk factors in the final model based on β-coefficients. We validated the model internally and externally. Results The echocardiographic score was constructed by multivariable logistic regression, which showed that pericardial effusion, right atrial (RA) area, RV outflow tract proximal diameter (RVOT-Prox), the velocity time integral of the right ventricular outflow tract (TVIRVOT) and S’ were predictors of high risk of pcPH. The area under curve (AUC) of the training set of the scoring model was 0.882 (95%CI: 0.809–0.956, p < 0.0001). External validation was tested in a test dataset of 77 patients. The AUC of the external validation set was 0.852. A 10-point score risk score was generated, with scores ranging from 0 to 10 in the training cohort. The estimate risk of high risk of pcPH ranged from 25.1 to 94.6%. Conclusions The echocardiographic risk score using five echocardiographic parameters could be comprehensive and useful to predict the high risk of pcPH for initial assessment and follow-up.

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Role of Echocardiogram in Predicting Prognosis in Pulmonary Arterial Hypertension: A Meta-Analysis

Cited by 4 publications

References 0 publications

The Growing Role of Echocardiography in Pulmonary Arterial Hypertension Risk Stratification: The Missing Piece

The Growing Role of Echocardiography in Pulmonary Arterial Hypertension Risk Stratification: The Missing Piece

Risk stratification and treatment goals in pulmonary arterial hypertension

Predicting high-risk pre-capillary pulmonary hypertension: an echocardiographic multiparameter scoring index

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