An echocardiographic surrogate for pulmonary arterial capacitance (ePAC) has been shown to be a reliable echocardiographic marker to independently predict mortality in patients with pulmonary hypertension (PH), according to a study published in the Journal of Cardiology.
This was a retrospective analysis of medical charts of patients with PH (n=302) who were managed at a PH comprehensive care center and had ≥1 clinic encounter between 2004 and 2018. The cumulative follow-up duration was 858 patient-years.
Patients who underwent a right heart catheterization (RHC) within 2 months of an echocardiogram were identified. Variables extracted from the charts included standard invasive, noninvasive, functional, and biochemical prognostic markers from the time of RHC. All-cause mortality was the study’s primary outcome.
There were 63 deaths over the cumulative follow-up period. Factors associated with all-cause mortality in this cohort were ePAC (standardized hazard ratio [HR], 0.68; 95% CI, 0.48-0.98; P =.036), RHC-PAC (HR, 0.68; 95% CI, 0.48-0.96; P =.027), echocardiographic pulmonary vascular resistance (HR, 1.29; 95% CI, 1.05–1.60; P =.017), 6-minute walk distance (HR, 0.43; 95% CI, 0.23-0.82; P =.01), and B-type natriuretic peptide (HR, 1.29; 95% CI, 1.03–1.62; P =.027).
ePAC remained a significant predictor of all-cause mortality, independent of age, gender, and multiple comorbidities in a multivariable-adjusted Cox analysis (standardized HR, 0.65; 95% CI, 0.45-0.95; P =.027).
In addition, a graded and stepwise association between ePAC tertiles (ie, low, <0.15cm/ mmHg; medium, 0.15-0.25cm/mmHg; and high, >0.25cm/mmHg) and all-cause mortality was established.
Limitations of the study include its retrospective and single-center design.
“We have demonstrated that ePAC is a readily available echocardiographic marker that independently predicts mortality in PH, and have provided clinically relevant ranges by which to risk-stratify patients and predict mortality,” concluded the study authors.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Papolos A, Tison GH, Mayfield J, Vasti E, DeMarco T. Echocardiographic assessment of pulmonary arterial capacitance predicts mortality in pulmonary hypertension. Published online November 3, 2020. J Cardiol. doi:10.1016/j.jjcc.2020.10.006