학술논문
Moderated Posters session: pulmonary hypertension and other conditions
Document Type
Article
Author
Baggen, VJM; Driessen, MMP; Post, MC; Van Dijk, AP; Roos-Hesselink, JW; Van Den Bosch, AE; Takkenberg, JJM; Sieswerda, GT; Spinelli, L; Giudice, C A; Castaldo, D; Pisani, A; Trimarco, B; Venner, C; Huttin, O; Mandry, D; Voilliot, D; Chabot, JF; Marie, PY; Juilliere, Y; Chaouat, A; Selton-Suty, C; Tuohinen, S; Skytta, T; Virtanen, V; Kellokumpu-Lehtinen, PL; Raatikainen, P; Konopka, M; Burkhard-Jagodzinska, K; Krol, W; Zdanowicz, R; Starczewski, M; Aniol-Strzyzewska, K; Jakubiak, A; Sitkowski, D; Dluzniewski, M; Braksator, W; Santoro, C; Buonauro, A; Bocchino, ML; Esposito, R; Canora, A; Vaccaro, A; Castaldo, S; Sanduzzi Zamparelli, A; Trimarco, B; Galderisi, M; Wahi, S; Chong, A; Krstic, I; Deljanin Ilic, M; Vrbic, S; Marinkovic, D; Ilic, S; Duchateau, N; Sermesant, M; Gibelin, P; Ferrari, E; Moceri, P; Handoko, M L; Di Pasqua, MC; Spruijt, OA; Oosterveer, FPT; Marcus, JT; Bogaard, HJ; Vonk Noordegraaf, A
Source
European Journal of Echocardiography; December 2015, Vol. 16 Issue: Supplement 2 pS67-S67, 1p
Subject
Language
ISSN
15252167; 15322114
Abstract
Purpose: Accurate prognostication is essential to guide clinical management in patients with pulmonary arterial hypertension (PAH). The goal of this study is to provide a comprehensive overview of the most thoroughly evaluated echocardiographic findings aiming to predict adverse outcome in PAH. Methods: MEDLINE and EMBASE electronic databases were systematically searched for longitudinal studies published by April 2015 that reported associations between echocardiographic findings and adverse clinical outcome in PAH. Studies were appraised using previously developed criteria for prognostic studies. Meta-analysis of echocardiographic findings investigated by ≥4 studies was performed using random effect models. In case of significant heterogeneity (I²>50% or Cochran’s Q p-value <0.10) additional sensitivity analyses were performed by excluding specific patient subgroups. Results: Thirty-seven papers investigating 6669 patients were included. Pooled hazard ratios and heterogeneity statistics are shown in the table. For TR severity and RV free wall LPSS no statistical heterogeneity was found, however the reported standard errors were generally larger. Sensitivity analyses did not change the overall results and conclusions for pericardial effusion, right atrial area and TAPSE. These results can be therefore regarded with a higher degree of certainty. Conclusions: This meta-analysis substantiates the clinical yield of specific echocardiographic findings in the prognostication of PAH patients in day-to-day practice. Especially, pericardial effusion, right atrial area and TAPSE are of prognostic value. Systematic review registration number: CRD42014009231. Prognostic value of echo findings in PAH No. of studies Hazard ratio 95% CI p-value I², % Cochran's Q (p-value) Presence of pericardial effusion 16 1.70 1.44-1.99 <0.001 42 25.7 (0.041) Right atrial area, per 5 cm² increase 5 1.71 1.38-2.13 <0.001 55 8.9 (0.063) RV systolic pressure, per 10 mmHg increase 7 1.18 1.01-1.38 0.043 76 25.1 (<0.001) Tricuspid regurgitation severity 7 2.20 1.64-2.95 <0.001 39 9.8 (0.133) Right atrial pressure, >15 mmHg 6 2.45 1.56-3.85 <0.001 76 20.7 (<0.001) TAPSE, per 5 mm increase 7 0.58 0.46-0.75 <0.001 77 26.1 (<0.001) RV fractional area change, per 5% increase 5 0.81 0.69-0.96 0.039 60 10.1 (0.039) Tei index, per 0.1 unit increase 7 1.23 1.09-1.40 0.001 73 22.3 (0.001) RV free wall longitudinal peak systolic strain, per 5% increase 4 1.72 1.53-1.93 <0.001 0 3.0 (0.392)