Two-dimensional echocardiography in the assessment of long-term prognosis in patients with pulmonary arterial hypertension.

OBJECTIVE: To investigate the relationship between cardiac diastolic dysfunction and outcomes in patients with pulmonary arterial hypertension (PAH) and to clarify the potential effect of two-dimensional echocardiography (2D-echo) on prognostic value in patients with PAH. METHODS: Patients diagnosed with PAH (as WSPH (World Symposia on Pulmonary Hypertension) classification I) confirmed by right heart catheterization (RHC), received targeted monotherapy or combination therapy. 2D-echo parameters, World Health Organization (WHO) functional classification and 6-minute walking distance (6MWD) were recorded. The clinical prognosis of patients was assessed by the correlation between echo parameters and clinical 6MWD using receiver operating characteristic (ROC) curve analysis. RESULTS: Fifty-eight patients were included. Left and right ventricular diastolic dysfunction (LVDD and RVDD) scores measured by 2D-echo had good correlation with 6MWD at baseline (rLVDD  = -0.699; rRVDD  = -0.818, both P < 0.001) and at last follow-up (rLVDD  = -0.701; rRVDD  = -0.666, both P<0.001). Furthermore, bi-ventricular (LVDD + RVDD) scores measured by 2D-echo had a better correlation with 6MWD at baseline and last follow-up (r =  0.831; r = -0.771, both P < 0.001). ROC curve analysis showed that the area under curves (AUCs) for LVDD score, RVDD score and (LVDD + RVDD) scores were 0.823 (P < 0.0001), 0.737 (P = 0.0002), and 0.825 (P < 0.0001), respectively. Compared with ROC analysis of other single parameters, cardiac diastolic function score was more accurate in predicting survival in patients with PAH. CONCLUSION: LVDD score, RVDD score and (LVDD + RVDD) scores yielded a comprehensive quantitative assessment of LV and RV diastolic function that correlated moderately with clinical functional parameters and might be useful in the assessment of PAH.