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Prognostic Value of the Persistence or Change in Pericardial Effusion Status on Serial Echocardiograms in Pulmonary Arterial Hypertension

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 (Unpublished)

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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:
CreatorsEmailPitt UsernameORCID
Dardari, Zeina A.zed4@pitt.eduZED4
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorArena, Vincent C.arena@pitt.eduARENA
Committee MemberPike, Francispikef@pitt.eduPIKEF
Committee MemberTalbott, Evelyn O.eot1@pitt.eduEOT1
Committee MemberYabes, Jonathan jgy2@gmail.com
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: Graduate 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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