• Chest · Nov 2017

    Ventricular diastolic pressure ratio as a marker of treatment response in pulmonary hypertension.

    • Arun Jose, Christopher S King, Oksana A Shlobin, Joseph M Kiernan, Nicolas A Cossa, A Whitney Brown, and Steven D Nathan.
    • Pulmonary, Critical Care, and Sleep Medicine Division, The George Washington University Medical Faculty Associates, Washington, DC. Electronic address: ajose2@gwu.edu.
    • Chest. 2017 Nov 1; 152 (5): 980-989.

    BackgroundPulmonary hypertension (PH) is diagnosed and classified through right-sided heart catheterization, with a number of hemodynamic markers used to help guide treatment decisions. These markers may not reflect the complex remodeling of the right ventricle or the interplay between ventricles and struggle to predict treatment response. This study investigates the use of a novel marker: the ratio of left ventricular end-diastolic pressure to right ventricular end-diastolic pressure (LVEDP/RVEDP) in predicting treatment outcomes in a cohort of patients with PH.MethodsWe performed a retrospective analysis of patients with PH at INOVA Fairfax Hospital's advanced lung disease program with simultaneous left-sided and right-sided heart catheterization. The primary end point was the time to clinical improvement, defined by an improvement in distance walked on the 6-min walk test (6MWT) of > 35 m in a year without interceding hospitalization for worsening PH or the need for additional PH therapy.ResultsA total of 51 patients were included in the final analysis, 21 of whom (41.2%) had a salutary treatment effect with a mean improvement in the 6MWT of 75 m. Treatment responders were more likely to have a lower LVEDP/RVEDP ratio (1.08 vs 1.62; P = .051). This association persisted in the final multivariate regression model after adjustment for age and sex and controlling for severity of PH (OR, 0.17; 95% CI, 0.03-0.65; P = .024).ConclusionsThe LVEDP/RVEDP ratio is a novel marker for therapeutic response in patients with PH treated with pulmonary vasodilator medications and may offer robust predictive value independent of existing markers of disease severity.Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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