Sandra V. Abramson, MD; James F. Burke, MD; John J. Kelly Jr., MD; James G. Kitchen III, MD; Michael J. Dougherty, MD; Donald F. Yih, MD; Frank C. McGeehin III, MD; John W. Shuck, MD; Thomas P. Phiambolis, MD
▪ Objective: To ascertain whether pulmonary hypertension, as assessed noninvasively by continuous-wave Doppler of tricuspid regurgitation, can be an important independent factor in the prognosis of patients with ischemic or idiopathic dilated cardiomyopathy.
▪ Design: Cohort study of consecutive patients with dilated cardiomyopathy in whom follow-up was obtained on all survivors for 28 months.
▪ Setting: Outpatient cardiology private practice office in a tertiary care center.
▪ Patients: Consecutive sample of 108 patients who presented for a scheduled office visit during a 15-month period.
▪ Measurements: M-mode, two-dimensional, and Doppler echocardiographic examinations were done on all patients at entry into the study and on survivors 1 year later. All examinations included extensive pulsed- and continuous-wave Doppler evaluation for tricuspid regurgitation.
▪ Main Outcome Measures: Overall mortality, mortality due to myocardial failure, and hospitalization for congestive heart failure.
▪ Results: Twenty-eight patients had a high velocity of tricuspid regurgitation (> 2.5 m/s), and 80 patients had a low velocity (≤ 2.5 m/s). After 28 months of follow-up, the mortality rate was 57% in patients with a high velocity compared with 17% in patients with a low velocity (difference of 40%, 95% Cl, 20% to 60%). Hospitalization for congestive heart failure occurred in 75% and 26% of patients, respectively (difference of 49%, Cl, 30% to 68%). Eighty-nine percent of patients with a high velocity either died or were hospitalized compared with only 32% of patients with a low velocity (difference of 57%, Cl, 42% to 72%). The peak velocity of tricuspid regurgitation was the only prognostic variable selected using stepwise logistic regression models for the three outcome events.
▪ Conclusion: Noninvasive assessment of pulmonary hypertension using continuous-wave Doppler of tricuspid regurgitation can predict morbidity and mortality in patients with ischemic or idiopathic dilated cardiomyopathy.
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Abramson SV, Burke JF, Kelly JJ, Kitchen JG, Dougherty MJ, Yih DF, et al. Pulmonary Hypertension Predicts Mortality and Morbidity in Patients with Dilated Cardiomyopathy. Ann Intern Med. 1992;116:888–895. doi: 10.7326/0003-4819-116-11-888
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Published: Ann Intern Med. 1992;116(11):888-895.
Cardiology, Pulmonary Hypertension, Pulmonary/Critical Care.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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