Predictors of poor outcome in patients with pulmonary arterial hypertension: A single center study.

OBJECTIVES: Pulmonary arterial hypertension (PAH) is a rare disorder with unfavorable prognosis despite implementation of specific PAH-oriented therapy. The aim of the study was to define predictors of poor prognosis in patients from one center treated according to the Polish National Health Fund program. PATIENTS AND METHODS: Forty-seven consecutive patients (30 women; aged 39±17 years) with PAH diagnosis were enrolled to the study. Clinical assessment, laboratory measurements, electrocardiogram, echocardiography, 6-minute walk test, 24-hour Holter monitoring, cardiopulmonary exercise test and microvolt T-wave alternans test were performed during routine visits. Eight patients died during 2.6±1.7 years follow-up. RESULTS: Parametrs which differentiated patients who died were brain natriuretic peptide (BNP) concentration ≥330 pg/mL (sensitivity 88%, specificity 92%, area under the ROC curve [AUC] 0.92); bilirubin concentration ≥1.2 mg/dL (sensitivity 88%, specificity 81%, AUC 0.85); right atrial area ≥21 cm2 (sensitivity 86%, specificity 69%, AUC 0.84), right ventricular (RV) dimension in the apical 4-chamber view ≥47 mm (sensitivity 86%, specificity 86%, AUC 0.85) and RV to left ventricular diastolic diameter ratio ≥1.5 (sensitivity 83%, specificity 84%; AUC 0.85). In multivariate analysis, independent predictors of mortality were higher BNP (p = 0.04) and bilirubin level (p = 0.03), higher right atrial area (p = 0.02) and lower tricuspid annular plane systolic excursion (p = 0.03). CONCLUSIONS: In PAH patients treated with specific PAH-oriented therapy right atrial enlargement, impaired right ventricular systolic function, as well as increased BNP and bilirubin concentration was associated with an increased mortality risk.

Prognostic factors in pulmonary arterial hypertension: Literature review.

Pulmonary arterial hypertension is a disease that has a bad influence on the patient's prognosis. Recently, the possibility of therapy has dramatically changed. Nowadays, the treatment of this disease is concerned mainly with the pathophysiological target. In clinical practice, it is important to start therapy at the appropriate time, when the patient is qualified because of an unsatisfactory examination result or improve therapy when the patient is getting worse. The understanding of prognosis factors in pulmonary arterial hypertension is necessary, because it is used to determine the length of patients' life expectancy. In September of 2015, new guidelines of ESC concerning the diagnosis and treatment of pulmonary hypertension have been presented. In our article we centered on the prognosis factor in pulmonary arterial hypertension. This document is a continuation of ESC guidelines. Many of the most contemporary articles are here summarized.

Microvolt T-wave alternans profiles in patients with pulmonary arterial hypertension compared to patients with left ventricular systolic dysfunction and a group of healthy volunteers.

OBJECTIVE: Microvolt T-wave alternans (MTWA) is a well-examined parameter for the risk stratification of sudden cardiac death (SCD) in patients with left ventricular dysfunction (LVD). However, the role of MTWA in pulmonary arterial hypertension (PAH) remains obscure. Consequently, the present study aimed to analyze the profile of MTWA among PAH patients in comparison with LVD patients and healthy volunteers. METHODS: The prospectively study included 22 patients with PAH (mean pulmonary artery pressure ≥ 25 mm Hg and pulmonary capillary wedge pressure ≤15 mm Hg during right heart catheterization; mean age, 40±17 years); 24 with LVD [left ventricular ejection fraction (LVEF) ≤35%; mean age, 40±11 years]; and 28 healthy volunteers (mean age, 41±8 years). Patients with persistent atrial arrhythmia were excluded. The MTWA (spectral method) categories were positive, negative, or indeterminate (MTWA_pos, MTWA_neg, or MTWA_ind, respectively). MTWA_pos and MTWA_ind were qualified as abnormal (MTWA_abn). Statistical analyses (Mann-Whitney U, chi-square with Yates's correction, Fisher's exact test) were performed. RESULTS: PAH patients had higher LVEF than LVD patients (61±7% vs. 27±7%; p<0.05). MTWA_abn was observed more frequently in the PAH and LVD groups than in the healthy volunteers. Patients with PAH were characterized by a considerable percentage of MTWA_pos and MTWA_abn (59% and 73%, respectively), but this did not differ from LVD patients. CONCLUSION: Patients with PAH are characterized by a high rate of MTWA abnormalities similar to LVD patients, despite the relevant differences in LVEF. Further research is required to elucidate the clinical significance and prognostic value of this data, particularly in the context of SCDunderlying mechanisms in PAH patients.

Plasma biomarkers as predictors of recurrence of atrial fibrillation.

INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia in the general population. There are numerous factors associated with the incidence and relapse of AF. It seems that some of them, such as neurohumoral changes, may affect AF-related atrial structural remodeling and lead to recurrence of AF. OBJECTIVES: The study aimed to assess the predictive value of plasma brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), aldosterone (ALD), and endothelin 1 (ET-1) concentrations before and after electrical cardioversion (CV). PATIENTS AND METHODS: The study included 60 patients with a dual-chamber pacemaker, persistent AF, and preserved left ventricular function who underwent successful CV. Blood samples were collected before and 24 hours and 7 days after CV. Recurrence of AF was identified by pacemaker logs lasting 30 minutes or longer. RESULTS: During a 12-month follow-up, only 5 patients (8%) had no recurrence of AF. Before cardioversion, ANP, ALD, and ET-1 levels were the same as those observed in the control group. BNP levels were significantly elevated and the level of 1237 fmol/ml or higher differentiated between patients with and without the recurrence of AF (sensitivity, 68%; specificity, 67%). Sinus rhythm restoration resulted in a significant decrease only in the BNP level. The BNP level of 700 fmol/ml or higher on day 7 after cardioversion was the most predictive for AF recurrence (sensitivity, 78%; specificity, 71%). In a multivariate analysis, only BNP levels of 700 fmol/ml or higher on day 7 after cardioversion (P = 0.04) and lack of amiodarone (P = 0.03) were independent predictors of AF recurrence. CONCLUSIONS: A BNP level of 700 fmol/ml or higher 7 days after cardioversion is an independent predictor of AF recurrence during 12 months after cardioversion. ANP, ALD, and ET-1 levels at baseline or 7 days after cardioversion are not predictive of AF recurrence.