Clinical validation of echocardiographic doppler-derived right ventricular dp/dtmax in patients with pulmonary arterial hypertension

Seventy-eight consecutive newly diagnosed untreated patients (64+15 years, 71% female, 57% PAH, 43% inoperable CTEPH) were included in the study. At baseline, patients were assessed clinically (New York Heart Association (NYHA)and6 minuteswalkingdistance(6MWD)),bytransthoraciccardiacultrasoundandbyrightheartcatherization. RV dp/dt was assessed using spectral Doppler recordings from the tricuspid regurgitation signal at a sweep speed of 200 mm/s by measuring the time interval in which the regurgitant velocity increased from 0.5 to 2 m/s. During a mean follow-up period of 3.5+1.7 years, 31 patients died and 3 received a lung transplant (study endpoint reached in 34/78 (44%) patients). The optimal RV dp/dt cut-off was determined by receiver operating characteristic analysis at 3yearstobe410 mmHg/s(specificity84%,positive-predictivevalue55%,andnegative-predictivevalue83%).Inunivari- ate analysis, RV dp/dt ,410 mmHg/s (hazard ratio 2.67, 95% CI 1.30-5.47, P ¼ 0.007), tricuspid annulus plane systolic excursion (TAPSE) ,15 mm, NYHA, 6MWD, and right atrial pressure were predictors of mortality. In a multivariate model with TAPSE, RV dp/dt remained an independent predictor of mortality (P ¼ 0.01). Conclusion A reduced baseline RV dp/dt is a clear indicator of poor outcome independent of TAPSE in patients with PAH/CTEPH.