Background: Right ventricular (RV) imaging has not a definite role in risk stratification of pulmonary arterial hypertension (PAH) patients. We tested the hypothesis that echocardiography-derived phenotypes, depicting different degrees of RV remodeling and dysfunction, may provide additional prognostic information to current risk stratification tools. Methods: Consecutive incident PAH patients aged ≥18 years, diagnosed between January 2005 and December 2021, underwent clinical assessment, right heart catheterization, standard echocardiography. Simple echocardiographic variables were combined in order to define a priori four phenotypes representing different degrees of RV dilatation and RV-pulmonary arterial (PA) coupling: Phenotype 1 with mildy dilated right ventricle and preserved RV-PA coupling (n = 152 patients); phenotype 2 with mildly dilated right ventricle and poor RV-PA coupling (n = 143 patients); phenotype 3 with severely dilated right ventricle and preserved RV-PA coupling (n = 201 patients); phenotype 4 with severely dilated right ventricle and poor RV-PA coupling, with or without severe tricuspid regurgitation (n = 519 patients). Risk stratification was based on the European Society of Cardiology/European Respiratory Society (ESC/ERS) 3-strata model and Registry to Evaluate Early and Long-Term PAH disease Management (REVEAL) 2.0 score. Results: These phenotypes were present in all risk groups. Notably, regardless of the ESC/ERS risk stratum assigned to the patient, phenotype 4 was associated with a 2-fold increase of the odds of death (HR 2.1, 95% CI 1.6-2.8, p < 0.001), while phenotype 1 was associated with a 71% reduction in the odds of dying (HR 0.29, 95% CI 0.18-0.47, p < 0.001). Conclusions: Echocardiography-derived phenotypes describing RV remodeling and dysfunction may provide prognostic information which is independent of and additional to the clinically defined risk in incident PAH patients.

Right ventricular phenotyping in incident patients with idiopathic pulmonary arterial hypertension / Ghio, Stefano; Badagliacca, Roberto; D'Alto, Michele; Scelsi, Laura; Argiento, Paola; Brunetti, Natale D.; Casu, Gavino; Cedrone, Nadia; Confalonieri, Marco; Corda, Marco; Correale, Michele; D'Agostino, Carlo; De Tommasi, Elisabetta; Filomena, Domenico; Galgano, Giuseppe; Greco, Alessandra; Grimaldi, Massimo; Lombardi, Carlo; Madonna, Rosalinda; Manzi, Giovanna; Mercurio, Valentina; Mihai, Alexandra; Mulè, Massimiliano; Paciocco, Giuseppe; Papa, Silvia; Recchioni, Tommaso; Romaniello, Antonella; Romeo, Emanuele; Stolfo, Davide; Vitulo, Patrizio; Benza, Raymond L.; Vizza, Carmine D.. - In: THE JOURNAL OF HEART AND LUNG TRANSPLANTATION. - ISSN 1053-2498. - (2024). [10.1016/j.healun.2024.06.003]

Right ventricular phenotyping in incident patients with idiopathic pulmonary arterial hypertension

Casu, Gavino;Corda, Marco;
2024-01-01

Abstract

Background: Right ventricular (RV) imaging has not a definite role in risk stratification of pulmonary arterial hypertension (PAH) patients. We tested the hypothesis that echocardiography-derived phenotypes, depicting different degrees of RV remodeling and dysfunction, may provide additional prognostic information to current risk stratification tools. Methods: Consecutive incident PAH patients aged ≥18 years, diagnosed between January 2005 and December 2021, underwent clinical assessment, right heart catheterization, standard echocardiography. Simple echocardiographic variables were combined in order to define a priori four phenotypes representing different degrees of RV dilatation and RV-pulmonary arterial (PA) coupling: Phenotype 1 with mildy dilated right ventricle and preserved RV-PA coupling (n = 152 patients); phenotype 2 with mildly dilated right ventricle and poor RV-PA coupling (n = 143 patients); phenotype 3 with severely dilated right ventricle and preserved RV-PA coupling (n = 201 patients); phenotype 4 with severely dilated right ventricle and poor RV-PA coupling, with or without severe tricuspid regurgitation (n = 519 patients). Risk stratification was based on the European Society of Cardiology/European Respiratory Society (ESC/ERS) 3-strata model and Registry to Evaluate Early and Long-Term PAH disease Management (REVEAL) 2.0 score. Results: These phenotypes were present in all risk groups. Notably, regardless of the ESC/ERS risk stratum assigned to the patient, phenotype 4 was associated with a 2-fold increase of the odds of death (HR 2.1, 95% CI 1.6-2.8, p < 0.001), while phenotype 1 was associated with a 71% reduction in the odds of dying (HR 0.29, 95% CI 0.18-0.47, p < 0.001). Conclusions: Echocardiography-derived phenotypes describing RV remodeling and dysfunction may provide prognostic information which is independent of and additional to the clinically defined risk in incident PAH patients.
2024
Right ventricular phenotyping in incident patients with idiopathic pulmonary arterial hypertension / Ghio, Stefano; Badagliacca, Roberto; D'Alto, Michele; Scelsi, Laura; Argiento, Paola; Brunetti, Natale D.; Casu, Gavino; Cedrone, Nadia; Confalonieri, Marco; Corda, Marco; Correale, Michele; D'Agostino, Carlo; De Tommasi, Elisabetta; Filomena, Domenico; Galgano, Giuseppe; Greco, Alessandra; Grimaldi, Massimo; Lombardi, Carlo; Madonna, Rosalinda; Manzi, Giovanna; Mercurio, Valentina; Mihai, Alexandra; Mulè, Massimiliano; Paciocco, Giuseppe; Papa, Silvia; Recchioni, Tommaso; Romaniello, Antonella; Romeo, Emanuele; Stolfo, Davide; Vitulo, Patrizio; Benza, Raymond L.; Vizza, Carmine D.. - In: THE JOURNAL OF HEART AND LUNG TRANSPLANTATION. - ISSN 1053-2498. - (2024). [10.1016/j.healun.2024.06.003]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11388/339929
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