Ventricular diastolic pressure ratio as a marker of treatment response in pulmonary hypertension

Background

Pulmonary hypertension (PH) is diagnosed and classified through right heart catheterization (RHC), with a number of hemodynamic markers used to help guide treatment decisions. These markers may not reflect the complex remodeling of the right ventricle or the interplay between ventricles, and struggle to predict treatment response. This study investigates the use of a novel marker; the ratio of left to right ventricular end-diastolic pressures (LVEDP/RVEDP), in predicting treatment outcomes in a cohort of PH patients.

Methods

We performed a retrospective analysis of PH patients at INOVA Fairfax Hospital Advanced Lung Disease Program with simultaneous left- and right-heart catheterization. The primary endpoint was the time to clinical improvement, defined by an improvement in distance walked on the 6MWT of greater than 35 meters in a year without interceding hospitalization for worsening PH or need for additional PH therapy.

Results

A total of 51 patients were included in the final analysis, of which 21 (41.2%) had a salutary treatment effect with a mean improvement in the 6MWT of 75 meters. Treatment responders were more likely to have a lower LVEDP/RVEDP ratio (1.08 vs 1.62, p=0.051). This association persisted in the final multivariate regression model after adjustment for age, gender, and controlling for severity of pulmonary hypertension (OR 0.17, 95% confidence interval 0.03-0.65, p=0.024).

Conclusion

The LVEDP/RVEDP ratio is a novel marker for therapeutic response in PH patients treated with pulmonary vasodilator medications, and may offer robust predictive value independent of existing markers of disease severity.

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