Steven M Kawut1, Nadine Al-Naamani2, Cara Agerstrand2, Erika Berman Rosenzweig3, Cherise Rowan3, Robyn J Barst3, Steven Bergmann4, Evelyn M Horn2. 1. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY. Electronic address: kawut@mail.med.upenn.edu. 2. Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY. 3. Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY. 4. Department of Medicine, Beth Israel Medical Center, New York, NY.
Abstract
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.
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.
Authors: Micah R Fisher; Stephen C Mathai; Hunter C Champion; Reda E Girgis; Traci Housten-Harris; Laura Hummers; Jerry A Krishnan; Fredrick Wigley; Paul M Hassoun Journal: Arthritis Rheum Date: 2006-09
Authors: Serge A van Wolferen; Johannes T Marcus; Anco Boonstra; Koen M J Marques; Jean G F Bronzwaer; Marieke D Spreeuwenberg; Pieter E Postmus; Anton Vonk-Noordegraaf Journal: Eur Heart J Date: 2007-01-22 Impact factor: 29.983
Authors: Gábor Szabó; Pál Soós; Susanne Bährle; Tamás Radovits; Ernst Weigang; Violetta Kékesi; Béla Merkely; Siegfried Hagl Journal: Ann Thorac Surg Date: 2006-09 Impact factor: 4.330
Authors: Serge A van Wolferen; J Tim Marcus; Nico Westerhof; Marieke D Spreeuwenberg; Koen M J Marques; Jean G F Bronzwaer; Ivo R Henkens; C Tji-Joong Gan; Anco Boonstra; Pieter E Postmus; Anton Vonk-Noordegraaf Journal: Eur Heart J Date: 2007-12-08 Impact factor: 29.983
Authors: Bruno K Podesser; Mohit Jain; Soeun Ngoy; Carl S Apstein; Franz R Eberli Journal: Eur J Cardiothorac Surg Date: 2006-12-18 Impact factor: 4.191
Authors: Gerry P McCann; C T Gan; Aernout M Beek; Hans W M Niessen; Anton Vonk Noordegraaf; Albert C van Rossum Journal: AJR Am J Roentgenol Date: 2007-02 Impact factor: 3.959
Authors: Harikrishna Tandri; Samantapudi K Daya; Khurram Nasir; Chandra Bomma; João A C Lima; Hugh Calkins; David A Bluemke Journal: Am J Cardiol Date: 2006-10-27 Impact factor: 2.778
Authors: François Alla; Ahmad Y Al-Hindi; Craig R Lee; Todd A Schwartz; J Herbert Patterson; Kirkwood F Adams Journal: Am Heart J Date: 2007-06 Impact factor: 4.749
Authors: Serpil Erzurum; Sharon I Rounds; Troy Stevens; Micheala Aldred; Jason Aliotta; Stephen L Archer; Kewal Asosingh; Robert Balaban; Natalie Bauer; Jahar Bhattacharya; Harm Bogaard; Gaurav Choudhary; Gerald W Dorn; Raed Dweik; Karen Fagan; Michael Fallon; Toren Finkel; Mark Geraci; Mark T Gladwin; Paul M Hassoun; Marc Humbert; Naftali Kaminski; Steven M Kawut; Joseph Loscalzo; Donald McDonald; Ivan F McMurtry; John Newman; Mark Nicolls; Marlene Rabinovitch; Judy Shizuru; Masahiko Oka; Peter Polgar; David Rodman; Paul Schumacker; Kurt Stenmark; Rubin Tuder; Norbert Voelkel; Eugene Sullivan; Richard Weinshilboum; Mervin C Yoder; Yingming Zhao; Dorothy Gail; Timothy M Moore Journal: Am J Respir Crit Care Med Date: 2010-09-10 Impact factor: 21.405
Authors: Aránzazu Campo; Stephen C Mathai; Jérôme Le Pavec; Ari L Zaiman; Laura K Hummers; Danielle Boyce; Traci Housten; Hunter C Champion; Noah Lechtzin; Fredrick M Wigley; Reda E Girgis; Paul M Hassoun Journal: Am J Respir Crit Care Med Date: 2010-03-25 Impact factor: 21.405
Authors: Nicole B Gabler; Benjamin French; Brian L Strom; Ziyue Liu; Harold I Palevsky; Darren B Taichman; Steven M Kawut; Scott D Halpern Journal: Chest Date: 2011-09-22 Impact factor: 9.410