Dardari, Zeina A.
(2013)
Prognostic Value of the Persistence or Change in Pericardial Effusion Status on Serial Echocardiograms in Pulmonary Arterial Hypertension.
Master's Thesis, University of Pittsburgh.
(Unpublished)
Abstract
Background: Pericardial effusion in pulmonary arterial hypertension (PAH) is an indicator of right heart failure and a marker of poor prognosis; its significance on serial transthoracic echocardiograms (TTE) is not clear.
Methods: We examined our database for PAH patients followed at our center (10/99-11/07). Baseline and follow-up TTE (1.0±0.5y) and outcomes were studied (N=200). The presence of pericardial effusion was evaluated at baseline and follow-up. The persistence or change in pericardial effusion status was categorized into four categories. Kaplan Meier methods were used to estimate survival functions of the various categories. Cox proportional hazards modeling was used to adjust for other covariates and identify independent predictors.
Results: Over a mean follow-up of 4.6 ± 2.6 y, 53% (n=106) patients died. Pericardial effusion was present in 20% (n=40) at baseline and 22% (n=44) during follow up. Patients with pericardial effusion at baseline or follow-up had significantly higher creatinine, pulmonary vascular resistance, lower cardiac output, and were more likely to be treated with prostanoids. During follow-up, there was significantly increased prostanoids (58% vs. 28%) and combination therapy (8% vs. 2%) use compared to baseline. New or persistence of pericardial effusion was associated with worse outcomes (p<0.001) and an independent predictor of survival after adjusting for age, creatinine, sodium, cardiac output, mean right atrial pressure, New York Heart
Association (NYHA ) functional class, and presence of connective tissue disease as the etiology of PAH (p-value<0.001).
Conclusion: New or persistent pericardial effusion in PAH despite vasoactive therapy predicts worse outcomes; absence or resolution of pericardial effusion with therapy suggests better prognosis. Its public health significance is the ability to identify patients that may benefit from closer follow-up for reassessment and consideration of more aggressive medical therapy or referral for lung transplant to prevent worsening health and/or death.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
| Creators | Email | Pitt Username | ORCID  |
|---|
| Dardari, Zeina A. | zed4@pitt.edu | ZED4 | |
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| ETD Committee: |
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| Date: |
27 June 2013 |
| Date Type: |
Publication |
| Defense Date: |
12 April 2013 |
| Approval Date: |
27 June 2013 |
| Submission Date: |
3 April 2013 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
38 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Biostatistics |
| Degree: |
MS - Master of Science |
| Thesis Type: |
Master's Thesis |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Pericardial Effusion Heart Lung Pulmonary Arterial Hypertension Echocardiograms |
| Date Deposited: |
27 Jun 2013 18:36 |
| Last Modified: |
13 Mar 2019 17:33 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/18615 |
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