Chest. 2013 May 9. doi: 10.1378/chest.12-2659. [Epub ahead of print]

Left ventricular ejection time in acute heart failure complicating pre-capillary pulmonary hypertension.

Sztrymf B, Günther S, Artaud-Macari E, Savale L, Jaïs X, Sitbon O, Simonneau G, Humbert M, Chemla D.

Abstract

ABSTRACT BACKGROUND: Novel non-invasive tools may improve the management of patients with pulmonary arterial hypertension (PAH) experiencing heart failure. Major right ventricle overload leads to decreased stroke volume, which shortens left ventricular ejection time (LVET). Our arterial tonometry study tested the hypothesis that LVET carries prognostic value in PAH patients with heart failure.
METHODS: Clinical, biological and radial artery tonometry variables were prospectively obtained at admission and at day 3-5 in 53 consecutive PAH patients admitted in our ICU for clinical deterioration. LVET was measured from the reconstructed aortic pressure curve.
RESULTS: Overall ICU mortality (median stay 5 days) was 17% and 28%. At admission, the LVET was shorter in patients with unfavourable outcome (median 228 ms (212-278) vs 257 ms (237-277), p=0.032), while other tonometric indices were similar. The LVET at entry (237 ms) had 73% sensitivity and 89% specificity for identifying death in the ICU. Other prognostic factors at admission were higher serum levels of brain natriuretic peptide (BNP) and creatinine, and lower natremia. Dobutamine requirement, higher furosemide dose and higher oxygen flow were associated with unfavourable outcome. At the second evaluation, higher serum level of creatinine and BNP, higher furosemide dose and oxygen flow, and dobutamine or norepinephrine requirement were associated with poor outcome. The change in LVET between admission and follow-up measurement was not associated with outcome. The 90-day mortality was 28%.
CONCLUSIONS: Shortened LVET at ICU admission was a prognostic factor in PAH with heart failure. Previously documented prognostic factors were also confirmed in this cohort.

PMID:23670726