Abstract

CURSACK¹*, Guillermo et al. Severe right ventricular dysfunction by echocardiography in pulmonary arterial hypertension:: prevalence, clinical predictors, echocardiograph and treatment. Insuf. card. [online]. 2017, vol.12, n.1, pp.16-23. ISSN 1852-3862.

Introduction. Severe right ventricular dysfunction (SRVD) is a high risk marker in patients with pulmonary arterial hypertension (PAH). However, its clinical characteristics in Latin-Americans are poorly known. Objective. We sought to assess the prevalence, clinical markers and treatment of SRVD in Argentinean patients with PAH. Material and methods. Between Jan-10/Dec-11, 422 patients with diagnosis of pulmonary hypertension were prospectively included in 31 centers from 13 provinces from Argentina. Of them, 124 (29.4%) with diagnosis of PAH were included in the present analysis. SRVD was defined by moderate to severe RV dysfunction or TAPSE <15 mm. Results. Mean age was 45±17 and 78% were female. In logistic regression analysis, independent clinical predictors were fatigue (HR=5.2, 95%CI=1.9-14.1, p=0.001), heart rate (HR=1.045, 95%CI=1.003-1.088, p=0.033), and cardiomegaly (HR=2.9, 95%CI=1.2-7.5, p=0,024). Echocardiogram in SRVD showed more frequently right atrial dilation (84 vs 61%, p=0.013), and higher systolic pulmonary artery pressure (89±28 vs 77±27 mmHg, p=0.045), with lower left ventricular ejection fraction (59±12 vs 67±10 %, p=0.002). Treatment in SRVD was different in the use of diuretics (87 vs 63%, p=0.010) and digoxin (38 vs 20%, p=0.031), and it was similar in the use of sildenafil (87 vs 74%); iloprost (11 vs 10%); bosentan (19 vs 9%); treprostinil (5 vs 5%), and ambrisentan (5 vs 5%). Conclusion. One out of three patients with PAH presented SRVD. Physical examination and chest x-ray permit clinical identification. These patients received similar rate of specific drugs, suggesting the need of optimization of therapy driven to PAH in these more severe cases.

Keywords : Arterial pulmonary hypertension; Right ventricular dysfunction; Vascular resistance; Pulmonary circulation; Heart diseases; Argentine.

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