Ventricular Function and Cardio-Ankle Vascular Index in Patients With Pulmonary Artery Hypertension

Figures & data

Table 1 Vital Signs, Baseline Characteristics of Pulmonary Arterial Hypertension Patients and Control Group (M±SD, n (%))

Characteristics	IPAH Group n=37	Control Group n=20	P One-Way ANOVA/ Mann–Whitney U-Test
Age, years	48.4±12.6	45.5±15.6	NS
Height, cm	167.5±8.1	168.9±7.4	NS
Weight, kg	71.9±14.5	71.5±13.3	NS
BMI, kg/m^2	25.6±4.7	25.1±4.5	NS
Office SBP, mmHg	118.1±16.5	119.4±13.1	NS
Office DBP, mmHg	75.8±10.5	74.1±7.5	NS
Office HR, beats/min	81.2±15.4	71.6±4.1	<0.001/<0.001
GFR (CKD-EPI 2021), mL/min/1.73m^2	67.4±18.8	92.2±20.1	<0.001/<0.001
Glucose, mmol/l	5.36±1.22	5.1±2.2	NS
Total cholesterol, mmol/l	5.17±1.17	4.6±3.6	NS
Triglycerides, mmol/l	1.02±0.42	0.78±1.1	NS
Uric acid, µmol/l	401.8±127.1	363.2±12.5	NS
NT-proBNP, pg/mL	2089.1±1155	62.9±53.4	<0.001/<0.001
Ferritin, ng/mL	81.3±83.6	280.3±78.6	0.005/<0.003
TSH, mkU/mL	2.8±1.8	2.9±2.2	NS
6MWT SBP baseline, mmHg	113.1±13.1	112.4±11.1	NS
6MWT DBP baseline, mmHg	71.6±7.8	72.1±5.5	NS
6MWT HR baseline, beats/min	80.1±13.2	70.6±5.1	0.005/0.003
6MWT SaO2 baseline, %	93.4±4.0	97.7±0.8	<0.001/<0.001
6MWT Borg baseline, points	0.5±1.5	0	<0.001/<0.001
6MWT SBP at the end, mmHg	121.7±19.1	126.2±14.1	NS
6MWT DBP at the end, mmHg	74.7±9.8	79.4±8.7	NS
6MWT HR at the end, beats/min	104.4±19.4	91.2±12.8	0.006/0.003
6MWT SaO2 at the end, %	90.0±9.0	97.8±0.8	<0.001/<0.001
6MWT distance, m	369.7±95.1	564.8±58.9	<0.001/<0.001
6MWT Borg at the end, points	5.9±1.9	1.2±1.2	<0.001/<0.001
CAVI right	8.5±1.8	7.8±1.1	NS
CAVI left	8.7±1.1	7.5±0.9	0.002/0.007
Male/female, n (%)	9 (24.3)/28 (75.7)	5 (25)/15 (75)	NS/NS
Atrial fibrillation history, n (%)	3 (8.1)	-
Ascites, n (%)	3 (8.1)	-
Syncope history, n (%)	7 (18.9)	-
WHO f.c. IV, n (%)	1 (2.7)	-
WHO f.c. III, n (%)	30 (81.1)	-
WHO f.c. II, n (%)	6 (16.2)	-
The right heart cathetherisation data*
SPAP, mmHg	92.0±21.4	-
DPAP, mmHg	39.6±8.2	-
MeanPAP, mmHg	57.0±11.1	-
Systolic RV pressure, mmHg	89.8±20.7	-
Diastolic RV pressure, mmHg	7.4±3.9	-
Mean RV pressure, mmHg	34.8±7.9	-
Mean RAP, mmHg	9.8±4.8	-
PAWP, mmHg	9.1±3.4	-
Cardiac output, l/min	4.54±1.48	-
Cardiac index, l/min/m^2	2.44±0.72	-
Stroke volume, mL	61.6±21.7	-
PVR, dynes*c/cm^5	951.2±434.6	-
HR, beats/min	75.7±12.7	-
Systemic SBP, mmHg	126.5±17.7	-
Systemic DBP, mmHg	83.6±11.4	-
Systemic mean BP, mmHg	97.9±13.1	-
SVR, dynes*c/cm^5	1645.3±671.3	-
TPR, dynes*c/cm^5	1129.7±483.2	-

Note: *Data obtained for pulmonary hypertension patients only.

Abbreviations: BMI, body mass index; BP, blood pressure; CAVI, cardio-ankle vascular index; CKD-EPI, chronic kidney disease Epidemiology Collaboration; DBP, diastolic blood pressure; DPAP, diastolic pulmonary artery pressure; GFR, glomerular filtration rate; HR, heart rate; LV, left ventricle; NT-proBNP, N-terminal pro-B-type natriuretic peptide; 6MWT, 6-minute walk test; PAP, pulmonary artery pressure; RAP, right atrial pressure; PAWP, pulmonary artery wedge pressure; PVR, pulmonary vascular resistance; RV, right ventricle; SaO2, oxygen saturation; SBP, systolic blood pressure; SPAP, systolic pulmonary artery pressure; SVR- systemic vascular resistance; TPR, total pulmonary resistance; TSH, thyroid-stimulating hormone; WHO f.c., World Health Organization functional class.

Table 2 Echocardiographic Parameters in Observed Groups (M±SD)

Parameters	IPAH Group n=37	Control Group n=20	P One-Way ANOVA/ Mann–Whitney-U Test
Aorta size, cm	2.91±0.37	2.85±0.39	NS
LA size, cm	3.35±0.66	3.70±0.38	0.044/0.87
LA square, cm^2	15.98±4.10	16.84±2.87	NS
LA volume index, mL/m^2	21.9±7.2	27.6±4.4	0.003/0.007
RA square, cm^2	27.5±9.7	15.1±2.5	<0.001/<0.001
RA volume index, mL/m^2	60.8±37.3	21.95±4.30	<0.001/<0.001
End systolic LV volume, mL	28.6±9.9	39.7±8.4	<0.001/<0.001
End diastolic LV volume, mL	79.6±21.8	102.5±19.5	<0.001/<0.001
End diastolic LV volume index, mL/m^2	43.1±10.9	55.1±8.3	<0.001/<0.001
Stroke volume, mL	50.9±13.9	62.8±13.2	0.004/0.01
Ejection fraction of LV, %	64.2±5.9	60.9±3.9	0.032/0.062
LV ejection time, ms	298.2±36.25	320.38±25.8	0.0187/0.04
Interventricular septal thickness, cm	0.9±0.09	0.89±0.11	NS
Posterior wall thickness, cm	0.87±0.08	0.87±0.09	NS
E/e’ at septal position	6.58±1.86	4.03±1.54	<0.001/<0.001
E/e’ at lateral position	5.9±2.1	3.8±1.56	<0.001/<0.001
Mean E/e’	4.7±3.1	3.9±1.5	NS
E/A ratio	0.86±0.35	1.11±0.47	0.04/0.11
Deceleration time, ms	192.9±42.9	192.0±35.2	NS
IVRT, ms	86.8±25.0	67.1±7.9	0.038/0.03
TAPSE, mm	16.32±3.1	22.9±2.8	<0.001/<0.001
Tricuspid regurgitation velocity, m/s	4.28±0.64	2.1±0.25	<0.001/<0.001
RV ejection time, ms	273.1±56.25	318.38±25.8	0.0013/0.026
Systolic PAP, mmHg	85.7±21.38	23.1±3.9	<0.001/<0.001
Eccentricity index in systole	1.98±0.59	1.0±0.02	<0.001/<0.001
Eccentricity index in diastole	1.62±0.41	1.01±0.21	<0.001/<0.001
RV GLS, %	−12.8±3.7	−21.13±2.71	<0.001/<0.001
RV SR, s^−1	0.9±0.3	1.7±0.6	<0.001/<0.001
LV GLS, %	−17.6±4.8	−21.8±1.4	0.001/0.001
LV SR, s^−1	1.05±0.26	1.43±0.25	<0.001/<0.001

Abbreviations: E/A ratio-early/late left ventricle filling ratio; E/e’ ratio, E-wave of mitral valve inflow/maximal velocity ratio; GLS, global longitudinal strain; IVRT, isovolumetric relaxation time; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; SR, strain rate; TAPSE, tricuspid annular plane systolic excursion; PAP, pulmonary artery pressure.

Table 3 The Characteristics of Idiopathic Arterial Hypertensive Patients in Subgroup CAVI> or < 8 (M±SD, n (%)

Parameters	CAVI ≤ 8 n=19	CAVI < 8 n=18	P One-Way ANOVA/ Mann–Whitney U-Test
Age, years	52.5±12.0	44.3±12.0	0.046/0.034
Height, cm	26.6±4.9	24.6±4.4	NS
Office SBP, mmHg	122.6±17.6	113.3±14.4	NS
Office DBP, mmHg	78.5±12.1	73.1±7.8	NS
Office HR, beats/min	81.8±16.8	80.5±14.3	NS
GFR (CKD-EPI 2021), mL/min/1.73m^2	61.6±17.9	73.5±18.1	0.052/0.075
Glucose, mmol/l	5.4±0.9	5.4±1.5	NS
Total cholesterol, mmol/l	5.3±1.3	4.9±1.0	NS
Triglycerides, mmol/l	0.98±0.42	1.1±0.4	NS
Uric acid, µmol/l	410.4±132.5	392.8±124.2	NS
Bilirubin, µmol/l	27.9±12.4	19.9±7.7	0.028/0.024
NT-proBNP, pg/mL	2475.4±1466.6	1681.5±1748.8	NS
Ferritin, ng/mL	78.5±75.7	85.6±86.2	NS
TSH, mkU/mL	2.7±1.6	2.9±2.0	NS
6MWT SBP baseline, mmHg	115.0±14.3	110.8±11.5	NS
6MWT DBP baseline, mmHg	71.1±6.8	72.1±9.1	NS
6MWT HR baseline, beats/min	79.1±14.5	81.4±11.8	NS
6MWT SaO2 baseline, %	94.7±3.9	93.1±4.1	NS
6MWT Borg baseline, points	0.5±1.4	0.5±1.5	NS
6MWT SBP at the end, mmHg	125.6±22.3	116.9±13.5	NS
6MWT DBP at the end, mmHg	75.2±10.6	74.0±8.9	NS
6MWT HR at the end, beats/min	101.9±23.2	107.3±14.1	NS
6MWT SaO2 at the end, %	92.1±4.7	87.8±11.8	NS
6MWT distance, m	370.4±82.1	368.9±109.1	NS
6MWT Borg at the end, points	5.9±1.8	5.8±2.0	NS
CAVI right	9.4±1.3	6.5±0.5	<0.001/<0.001
CAVI left	9.7±1.3	6.7±0.5	<0.001/<0.001
Mean PAP, mmHg	56.1±12.1	58.0±10.1	NS
Mean RAP, mmHg	10.1±4.8	9.4±4.9	NS
PAWP, mmHg	10.1±3.5	7.9±3.0	0.054/0.162
Cardiac output, l/min	4.24±1.1	4.85±1.8	NS
Cardiac index, l/min/m^2	2.2±0.6	2.7±0.84	0.053/0.159
Stroke volume, mL	59.2±16.7	63.9±25.8	NS
PVR, dynes*c/cm^5	964.8±482.6	936.8±391.1	NS
Systemic mean BP, mmHg	103.8±11.7	92.6±12.2	NS
SVR, dynes*c/cm^5	1749.8±707.2	1552.6±643.5	NS
TPR, dynes*c/cm^5	1174.3±537.9	1082.7±428.2	NS
Aorta size, cm	2.9±0.3	2.9±0.4	NS
LA square, cm^2	16.4±4.1	15.5±4.2	NS
LA volume, mL	43.9±16.3	35.7±9.8	NS
LA volume index, mL/m^2	23.2±8.6	20.5±5.1	NS
RA square, cm^2	27.2±10.5	27.8±8.9	NS
RA volume, mL	108.6±72.7	108.6±61.9	NS
RA volume index, mL/m^2	58.2±41.1	63.7±33.7	NS
End systolic LV volume, mL	29.9±9.0	27.2±10.8	NS
End diastolic LV volume, mL	82.2±20.5	76.8±23.5	NS
Stroke volume, mL	52.3±13.3	49.6±14.9	NS
Ejection fraction of LV, %	63.6±5.2	64.9±6.8	NS
LV Ejection time, ms	265.2±35.6	331.3±54.2	0.001/0.002
E/e’ at septal position	6.6±1.3	6.6±2.5	NS
E/e’ at lateral position	6.6±1.6	5.0±2.4	0.043/0.059
Mean E/e’	5.6±2.7	3.8±3.3	NS
E/A ratio	0.82±0.35	0.9±0.35	NS
Deceleration time, ms	192.8±45.7	192.9±40.4	NS
IVRT, ms	82.8±20.2	91.1±29.7	NS
TAPSE, mm	16.3±2.8	16.4±3.4	NS
RV Ejection time, ms	250.0±39.9	296.0±52.9	0.0047/0.003
PAAT, ms	80.8±20.5	82.4±17.7	NS
Systolic PAP, mmHg	82.3±27.4	89.2±12.1	NS
Eccentricity index in systole	1.9±0.65	2.06±0.5	NS
Eccentricity index in diastole	1.5±0.34	1.74±0.43	NS
RV GLS, %	−12.4±3.8	−13.2±3.7	NS
RV SR, s	0.84±0.34	0.96±0.29	NS
LV GLS, %	−18.4±5.7	−16.7±3.7	NS
LV SR, s	1.04±0.3	1.06±0.19	NS
Male/female, n (%)	3 (15.8)/16 (84.2)	6 (33.3)/12 (66.7)	NS
Ascites, n (%)	2 (10.5)	1 (5.6)	NS
Syncope history, n (%)	6 (31.6)	1 (5.6)	0.03/0.15
WHO f.c. IV, n (%)	1 (5.3)	-	NS
WHO f.c. III, n (%)	16 (84.2)	14 (77.8)	NS
WHO f.c. II, n (%)	2 (10.5)	4 (22.2)	NS

Abbreviations: CAVI, cardio-ankle vascular index; CKD-EPI, chronic kidney disease Epidemiology Collaboration; DBP, diastolic blood pressure, E/A ratio-early/late left ventricle filling ratio; E/e’ ratio, E-wave of mitral valve inflow/maximal velocity ratio; GLS, global longitudinal strain; GFR, glomerular filtration rate; IVRT, isovolumetric relaxation time; HR, heart rate; LA, left atrium; LV, left ventricle; NT-proBNP, N-terminal pro-B-type natriuretic peptide; 6MWT, 6-minute walk test; PAP, pulmonary artery pressure; PAAT, pulmonary artery acceleration time; PAWP, pulmonary artery wedge pressure; PVR, pulmonary vascular resistance; RA, right atrium; RAP, right atrial pressure; RV, right ventricle; SaO2, oxygen saturation; SBP, systolic blood pressure; SPAP, systolic pulmonary artery pressure; SVR- systemic vascular resistance; SR, strain rate; SBP, systolic blood pressure; TAPSE, tricuspid annular plane systolic excursion; TPR, total pulmonary resistance; TSH, thyroid-stimulating hormone; WHO f.c., World Health Organization functional class.