부산대학교 도서관

Aim: To determine which factors (clinical, echocardiographic and laboratorial,including new biomarkers) can better predict functional capacity in PulmonaryArterial Hypertension (PAH)Methods: Twenty consecutive patients (pts) (56 ± 15 years, 16 female) with severe pulmonary hypertension by clinical and hemodynamic criteria, in I and IV groups of Danna Point classification, were prospectively studied. Clinical and demographic evaluation were performed, as well as 6MWT, echocardiogram and laboratory evaluation in 72 hours.The investigation protocol included assessment of right ventricular function by conventional echocardiographic parameters and right ventricular myocardial deformation parameters derived from speckle tracking.Laboratory evaluation included biomarkers (NT-proBNP,copeptin, renin and aldosterone) and hemoglobin concentration determination.Results: The mean PASP was 82 ± 25mmHg and 80% (n = 16) were in WHO functional class II. The mean distance in 6MWT was 335 ± 80m.6MWT distance correlated negatively with adrenomedullin (R =- 0.56, p = 0.03), copeptin (R =- 0.66 p<0.01), aldosterone (R =- 0, 54, p = 0.04) and renin (R = 0.64, p = 0.01).Hemoglobin concentration correlates directly with mean 6MWT(R = 0.56, p = 0.03), but the NT-proBNP levels showed no correlation.The functional status correlated inversely with thedistance in the walk test (R =- 0.6, p = 0.03).The right ventricular diastolic dimension (R = 0.59, p =0.02) and peak systolic global strain rate of the right ventricle (R = 0.58, p= 0.02) correlated with the 6MWT.Copeptin and myocardial deformation parameters of the right ventricle were the only independent predictors of 6MWT results.Conclusion: Copeptin and right ventricular function assessment by speckle tracking are independent predictors of functional capacity in pulmonary hypertension and should probably be systematically assessed in patients with PAH.