Right Ventricular Cardiac Power Output as a Mortality Predictor in Patients with Pulmonary Arterial Hypertension

Abstract

Objectives:Right heart catheterization (RHC) is a gold standard method for diagnosis, also monitors the level of the disease, the prognosis, and the response to the therapy in patients with pulmonary arterial hypertension (PAH). Cardiac power output (CPO) is the product of flow and pressure. Aim of this study was to evaluate right ventricular cardiac power output (RVCPO) in PAH patients as a prognostic factor. Materials and methods: Demographic characteristics, functional class, RHC findings, echocardiographic data, PAH-specific medical treatment usage of 105 treatment-naïve, newly diagnosed Group 1 PAH patients between September 2009 and June 2019 were reviewed. RVCPO (Watt) was calculated as a product of cardiac output (CO) and mean pulmonary artery pressure (mPAP), divided by a constant of 451. Results: RVCPO was lower in high-risk patients (0,25 ± 0,02 W for high risk, 0,42 ± 0,15 W for low risk, and 0,44 ± 0,10 W for intermediate-risk; p=0.04) in comparison with low and intermediate-risk patients. RVCPO showed very high correlation with mPAP while a low positive correlation with CO, and PVR. 0,44 W for RVCPO was found the most accurate predictor value for mortality in low and intermediate-risk patients by ROC analysis. Conclusion: RVCPO could be a promising hemodynamic parameter that represents cardiac pumping ability with PAH patients. RVCPO tends to increase with low and intermediate risk while decrease with high-risk and associated with mortality above 0,44 W with low and intermediate-risk patients. We suggest that RVCPO could be a beneficial hemodynamic tool to discriminate the patients at-risk among the low and intermediate-risk groups.

Keywords

• pulmonary hypertension
• cardiac power output
• pulmonary circulation,
• right heart catheterization
• pulmonary arterial hypertension; cardiac power output; pulmonary circulation; right heart catheterization; right ventricle hemodynamics