Incremental utility of right ventricular dysfunction in patients with myeloproliferative neoplasm-associated pulmonary hypertension Journal Article


Authors: Kim, J.; Krichevsky, S.; Xie, L.; Palumbo, M. C.; Rodriguez-Diego, S.; Yum, B.; Brouwer, L.; Silver, R. T.; Schafer, A. I.; Ritchie, E. K.; Yabut, M. M.; Sosner, C.; Horn, E. M.; Devereux, R. B.; Scandura, J. M.; Weinsaft, J. W.
Article Title: Incremental utility of right ventricular dysfunction in patients with myeloproliferative neoplasm-associated pulmonary hypertension
Abstract: Background: Myeloproliferative neoplasm (MPN) has been associated with pulmonary hypertension (PH) on the basis of small observational studies, but the mechanism and clinical significance of PH in MPN are not well established. The aims of this study were to expand understanding of PH in a well-characterized MPN cohort via study of PH-related symptoms, mortality risk, and cardiac remodeling sequalae of PH using quantitative echocardiographic methods. Methods: The population comprised a retrospective cohort of patients with MPN who underwent transthoracic echocardiography: Doppler-derived pulmonary arterial systolic pressure applied established cutoffs for PH (≥35 mm Hg) and advanced PH (≥50 mm Hg); right ventricular (RV) performance was assessed via conventional indices (tricuspid annular plane systolic excursion [TAPSE], S′) and global longitudinal strain. Symptoms and mortality were discerned via standardized review. Results: Three hundred one patients were studied; 56% had echocardiography-demonstrated PH (20% advanced) paralleling a high prevalence (67%) among patients with invasively quantified PASP. PH was associated with adverse left ventricular (LV) remodeling indices, including increased myocardial mass and diastolic dysfunction (P ≤ .001 for all): LV mass and filling pressure (P < .01) were associated with PH independent of LV ejection fraction. RV dysfunction by strain and TAPSE and S′ increased in relation to PH (P ≤ .001) and was about threefold greater among patients with advanced PH compared with those without PH. Patients with RV dysfunction were more likely to report dyspnea, as were those with advanced PH (P < .05). During median follow-up of 2.2 years, all-cause mortality was 27%. PH grade (hazard ratio, 1.9; 95% CI, 1.1–3.0; P = .012) and TAPSE- and S′-demonstrated RV dysfunction (hazard ratio, 3.3; 95% CI, 1.3–8.2; P = .01) were independently associated with mortality; substitution of global longitudinal strain for TAPSE and S′ yielded similar associations of RV dysfunction with death (hazard ratio, 3.2; 95% CI, 1.5–6.7; P = .003) independent of PH. Conclusions: PH is highly prevalent in patients with MPN and is linked to LV diastolic dysfunction; echocardiography-quantified RV dysfunction augments risk for mortality independent of PH. © 2019 American Society of Echocardiography
Keywords: controlled study; aged; major clinical study; follow up; cohort analysis; retrospective study; dyspnea; quantitative analysis; systolic blood pressure; heart left ventricle ejection fraction; heart ventricle remodeling; myeloproliferative neoplasm; transthoracic echocardiography; heart right ventricle failure; pulmonary hypertension; clinical outcome; myeloproliferative neoplasms; independent variable; lung artery pressure; cardiovascular mortality; left ventricular diastolic dysfunction; heart left ventricle mass; human; male; female; article; cardio-oncology; right ventricle; heart right ventricle function; mortality risk; all cause mortality; heart left ventricle filling pressure; tricuspid annular plane systolic excursion
Journal Title: Journal of the American Society of Echocardiography
Volume: 32
Issue: 12
ISSN: 0894-7317
Publisher: Mosby Elsevier  
Date Published: 2019-12-01
Start Page: 1574
End Page: 1585
Language: English
DOI: 10.1016/j.echo.2019.07.010
PUBMED: 31587969
PROVIDER: scopus
PMCID: PMC6899198
DOI/URL:
Notes: Source: Scopus
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  1. Lola Xie
    4 Xie