Usefulness of scoring right ventricular function for assessment of prognostic factors in patients with chronic thromboembolic pulmonary hypertension

Right ventricular (RV) function is associated with prognosis in chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to establish an RV dysfunction score using RV echocardiographic parameters to clarify the clinical characteristics in patients with CTEPH and to compare RV dysfunction score with parameters such as World Health Organization (WHO) functional class, hemodynamics, exercise capacity, and plasma BNP level. We enrolled 35 inpatients with CTEPH (mean age, 62 +/- 15years, 15 males). We constructed an RV dysfunction score' calculated as the summation of each point awarded for the presence of four parameters: tricuspid annular plane systolic excursion (TAPSE)<16mm, 1 point; tissue Doppler-derived tricuspid lateral annular systolic velocity (S)<10cm/s, 1 point; right ventricular fractional area change (RVFAC)<35%, 1 point; and right ventricular myocardial performance index (RV-MPI)>0.4, 1 point. TAPSE, S, RVFAC, and RV-MPI was 18.7 +/- 4.8mm, 11.9 +/- 3.1cm/s, 33.5 +/- 13.9%, and0.39 +/- 0.2, respectively. The RV dysfunction score was associated with symptom [WHO functional class (p=0.026)], hemodynamics [mean PAP (p=0.01), cardiac index (p=0.009), pulmonary vascular resistance (p=0.001), and SvO(2) (p=0.039)], exercise capacity [6-min walk distance (p=0.046), peakVO(2) (p=0.016), and VE/VCO2 slope (p=0.031)], and plasma BNP level (p=0.005). This RV dysfunction score using the four RV echocardiographic parameters could be a simple and useful scoring system to evaluate prognostic factors in patients with CTEPH.