Circulation, Vol 80, 353-360, Copyright © 1989 by American Heart Association
SB Eysmann, HI Palevsky, N Reichek, K Hackney and PS Douglas
To determine correlates of survival in primary pulmonary hypertension, we
compared 41 echocardiography-Doppler and nine catheterization parameters
with outcome in 26 patients. Mean follow-up was 19.7 months in survivors;
mean survival was 4.8 months in 16 nonsurvivors. Cox life- table univariate
analysis correlated two echocardiographic, three Doppler, and three
catheterization variables with poor survival (p less than or equal to
0.05), and chi 2 analysis ensured the best critical values: severity of
pericardial effusion, heart rate of more than 87 beats/min, pulmonic flow
acceleration time of less than 62 msec, tricuspid early flow deceleration
(T-DEC) equal to or less than -300 cm2/sec, mitral early flow-to-atrial
flow velocity ratio (M-E/A) equal to or less than 1.0, catheterization
cardiac index (CI) equal to or less than 2.3 l/min/m2, mean pulmonary
artery pressure of more than 61 mm Hg, and diastolic pulmonary artery
pressure of more than 43 mm Hg. Multivariate life-table analysis of
noninvasive variables revealed the severity of pericardial effusion to be
independently significant (p = 0.006), whereas analysis of catheterization
variables revealed cardiac index to be independently significant (p =
0.014). Combined multivariate analysis did not differ from the noninvasive
results alone. Categorical modeling of the eight significant variables
split at their critical values (present or absent) revealed M-E/A, T-DEC,
and CI to be independently significant by multivariate analysis (p =
0.0014). Analysis of the five echocardiography-Doppler variables alone
revealed M-E/A, T-DEC, and heart rate to be independently significant (p =
0.0016). In both cases, mortality increased with the number of critical
values reached.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Two-dimensional and Doppler-echocardiographic and cardiac catheterization correlates of survival in primary pulmonary hypertension
Hospital of the University of Pennsylvania, Cardiovascular Section, Philadelphia 19104.
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