Two-dimensional and doppler-echocardiographic and cardiac catheterization correlates of survival in primary pulmonary hypertension

• Published in: Circulation (New York, N.Y.) Vol. 80; no. 2; pp. 353 - 360
• Main Authors: EYSMANN, S. B, PALEVSKY, H. I, REICHEK, N, HACKNEY, K, DOUGLAS, P. S
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.08.1989
• Subjects: Actuarial Analysis; Adult; Biological and medical sciences; Cardiac Catheterization; Cardiology. Vascular system; Chronic cor pulmonale; Echocardiography; Echocardiography, Doppler; Female; Heart; Humans; Hypertension, Pulmonary - diagnosis; Hypertension, Pulmonary - mortality; Male; Medical sciences; Models, Cardiovascular; Pneumology; Prognosis; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Statistics as Topic; Heart; Doppler ultrasound study; Human; Catheterization; Ultrasonic investigation; Cardiovascular disease; Survival; Pulmonary hypertension; Primitive; Electrocardiography; Pulmonary vascular disease; Hemodynamics; Two dimensional technique
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.80.2.353

To determine correlates of survival in primary pulmonary hypertension, we compared 41 echocardiography-Doppler and nine catheterization parameters with outcome in 26 patients. Mean follow-up was 19.7 months in survivors; mean survival was 4.8 months in 16 nonsurvivors. Cox life-table univariate analysis correlated two echocardiographic, three Doppler, and three catheterization variables with poor survival (p less than or equal to 0.05), and chi 2 analysis ensured the best critical values: severity of pericardial effusion, heart rate of more than 87 beats/min, pulmonic flow acceleration time of less than 62 msec, tricuspid early flow deceleration (T-DEC) equal to or less than -300 cm2/sec, mitral early flow-to-atrial flow velocity ratio (M-E/A) equal to or less than 1.0, catheterization cardiac index (CI) equal to or less than 2.3 l/min/m2, mean pulmonary artery pressure of more than 61 mm Hg, and diastolic pulmonary artery pressure of more than 43 mm Hg. Multivariate life-table analysis of noninvasive variables revealed the severity of pericardial effusion to be independently significant (p = 0.006), whereas analysis of catheterization variables revealed cardiac index to be independently significant (p = 0.014). Combined multivariate analysis did not differ from the noninvasive results alone. Categorical modeling of the eight significant variables split at their critical values (present or absent) revealed M-E/A, T-DEC, and CI to be independently significant by multivariate analysis (p = 0.0014). Analysis of the five echocardiography-Doppler variables alone revealed M-E/A, T-DEC, and heart rate to be independently significant (p = 0.0016). In both cases, mortality increased with the number of critical values reached.