Chest
Volume 135, Issue 3, March 2009, Pages 752-759
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Original Research
Pulmonary Arterial Hypertension
Determinants of Right Ventricular Ejection Fraction in Pulmonary Arterial Hypertension

https://doi.org/10.1378/chest.08-1758Get rights and content

Background

Right ventricular function is a key determinant of exercise capacity and survival in pulmonary arterial hypertension (PAH). We aimed to study the predictors of right ventricular ejection fraction (RVEF) in patients with newly diagnosed PAH.

Methods

We performed a cross-sectional analysis of a retrospective cohort of consecutive patients with idiopathic, familial, or anorexigen-associated PAH who underwent equilibrium radionuclide angiography for measurement of RVEF at baseline.

Results

Of the 84 patients in the cohort, 63 underwent equilibrium radionuclide angiography and right heart catheterization and were included. The mean age was 41 ± 13 years, and 79% of the patients were female. The mean RVEF was 30 ± 8%. RVEF was directly associated with right ventricular stroke volume index and cardiac index, and inversely associated with pulmonary vascular resistance index from right heart catheterization (all p < 0.001). Older age and male sex were associated with lower RVEF (p < 0.05) after adjustment for pulmonary vascular resistance index and left ventricular ejection fraction. Higher plasma von Willebrand factor levels were also independently associated with lower RVEF (p = 0.01) (n = 55). Body size and type of PAH were not associated with RVEF.

Conclusions

Older patients and males with PAH had lower RVEF at baseline than younger patients and females, even after controlling for left ventricular function and hemodynamics. Higher plasma von Willebrand factor levels, a marker of endothelial dysfunction, were also associated with lower RVEF.

Section snippets

Study Design

We performed a cross-sectional analysis within a retrospective cohort study of consecutive adult patients with PAH who underwent initial evaluation at our center between January 1994 and June 2002. The study was approved by the Institutional Review Board.

Study Subjects

Details of the cohort have been published previously.7, 15, 16 The following criteria were required for inclusion in this study: (1) PAH that was idiopathic, familial, or associated with anorexigen use; (2) age > 16 years; (3) initial

Patient Characteristics

The cohort included 84 patients evaluated during the study period. Of those, 63 had equilibrium radionuclide angiography and right heart catheterization performed at baseline and constituted the study sample. Of these patients, 86% had radionuclide angiography performed within seven days of the right heart catheterization. Table 1 shows the characteristics of the study sample and the excluded patients. The mean age in the study sample was 41 ± 13 years, 79% of the patients were female, 78% were

Discussion

RV structure and function are important determinants of long-term survival in PAH; however, little is known about the factors present at the time of diagnosis that affect RV performance in this disease. The mean RVEF at baseline in our cohort was 30%, well below the lower limit of normal, and only three patients in the cohort had normal RVEF. Other studies of patients with PAH have shown similar results.5, 17 While RVEF was significantly associated with hemodynamics, there was substantial

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    This study was supported by National Institutes of Health grants HL67771 and HL086719.

    The authors have no conflicts of interest to disclose.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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