Serial Measurements of Tricuspid Regurgitation Pressure Gradient by Echocardiography Predict Prognosis in Idiopathic Pulmonary Fibrosis

Authors

  • Yasuo Kitamura Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
  • Mitsuo Otsuka Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
  • Gen Yamada Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
  • Satoshi Yuda Department of Cardiology, Teine Keijinkai Hospital, Sapporo, Japan
  • Keiki Yokoo Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
  • Kimiyuki Ikeda Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
  • Koji Kuronuma Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
  • Hirofumi Chiba Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
  • Akiyoshi Hashimoto Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
  • Hiroki Takahashi Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan

DOI:

https://doi.org/10.17140/PRRMOJ-3-124

Keywords:

Tricuspid regurgitation pressure gradient, Idiopathic pulmonary fibrosis, echo-cardiography, Combined pulmonary fibrosis and emphysema

Abstract

Background and Objectives: Idiopathic Pulmonary Fibrosis (IPF), especially with emphysema, reportedly involved with Pulmonary Hypertension (PH). However, it is not elucidated whether pulmonary arterial pressure changes serially during the course and influence on prognosis in IPF. We examined whether serial measurements of Tricuspid Regurgitation Pressure Gradient (TRPG) by echocardiography were meaningful predictors of IPF patient survival.
Methods: We retrospectively investigated 83 IPF patients. The echocardiographic TRPG cutoff was set at 30 mmHg, and the subjects were divided into two groups: high TRPG and normal TRPG. We also evaluated the relationship between serial TRPG changes during follow-up.
Results: A total of 28 patients were included in the high TRPG group. The high TRPG group showed significantly lower %FVC and %DLco, higher A-aDO2, shorter 6-minute walk test distance, and more frequent emphysema than the normal TRPG group. The high TRPG group also had poorer survival than the normal TRPG group. A multivariate Cox proportional hazard model demonstrated that TRPG, %FVC, and A-aDO2 significantly affected patient survival. Thirty-six patients underwent echocardiography twice. At the time of the second echocardiography, 7 patients with normal TRPG at baseline (n=22) increased to a TRPG of more than 30 mmHg. These patients had significantly showed poorer survival.
Conclusions: TRPG is an independent prognostic factor in IPF. Emphysema involvement, de-creased DLco, and decreased FVC were associated with an increase in TRPG. Serial measurements of TRPG are recommended for the early detection of PH and predict prognosis in IPF patients.

References

Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/ JRS/ALAT statement: Idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011; 183(6): 788-824. doi: 10.1164/rccm.2009- 040GL

Rudd RM, Prescott RJ, Chalmers JC, Johnston ID. Fibrosing alveolitis subcommittee of the research committee of the British thoracic society. British Thoracic Society study on cryptogenic fibrosing alveolitis: response to treatment and survival. Thorax. 2007; 62(1): 62-66. doi: 10.1136/thx.2005.045591

Fernández Pérez ER, Daniels CE, Schroeder DR, et al. Inci-dence, prevalence, and clinical course of idiopathic pulmonary fibrosis: a population-based study. Chest. 2010; 137(1): 129- 137. doi: 10.1378/chest.09-1002

Natsuizaka M, Chiba H, Kuronuma K, et al. Epidemiologic survey of Japanese patients with idiopathic pulmonary fibro-sis and investigation of ethnic differences. Am J Respir Crit Care Med. 2014; 190(7): 773-779. doi: 10.1164/rccm.201403- 0566OC

Lettieri CJ, Nathan SD, Barnett SD, Ahmad S, Shorr AF. Prevalence and outcomes of pulmonary arterial hypertension in advanced idiopathic pulmonary fibrosis. Chest. 2006; 129(3): 746-752. doi: 10.1378/chest.129.3.746

Nadrous HF, Pellikka PA, Krowka MJ, et al. Pulmonary hy-pertension in patients with idiopathic pulmonary fibrosis. Chest. 2005; 128(4): 2393-2399. doi: 10.1378/chest.128.4.2393

Mejía M, Carrillo G, Rojas-Serrano J, et al. Idiopathic pul-monary fibrosis and emphysema: decreased survival associ-ated with severe pulmonary arterial hypertension. Chest. 2009; 136(1): 10-15. doi: 10.1378/chest.08-2306

Cottin V, Nunes H, Brillet PY, et al. Combined pulmonary fibro-sis and emphysema: a distinct underrecognised entity. Eur Respir J. 2005; 26(4): 586-593. doi: 10.1183/09031936.05.00021005

Galiè N, Hoeper MM, Humbert M, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2009; 34(1): 1219-1263. doi: 10.1093/eurheartj/ehp297

Goto K, Arai M, Watanabe A, Hasegawa A, Nakano A, Kura-bayashi M. Utility of echocardiography versus BNP level for the prediction of pulmonary arterial pressure in patients with pul-monary arterial hypertension. Int Heart J. 2010; 51(5): 343-347. doi: 10.1536/ihj.51.343

Arcasoy SM, Christie JD, Ferrari VA, et al. Echocardio-graphic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med. 2003; 167(5): 735-740. doi: 10.1164/rccm.200210-1130OC

Nathan SD, Shlobin OA, Barnett SD, et al. Right ventricular systolic pressure by echocardiography as a predictor of pulmo-nary hypertension in idiopathic pulmonary fibrosis. Respir Med. 2008; 102(9): 1305-1310. doi: 10.1016/j.rmed.2008.03.022

Song JW, Song JK, Kim DS. Echocardiography and brain natriuretic peptide as prognostic indicators in idiopathic pulmo-nary fibrosis. Respir Med. 2009; 103(2): 180-186. doi: 10.1016/j. rmed.2008.11.012

Goddard PR, Nicholson EM, Laszlo G, Watt I. Computed to-mography in pulmonary emphysema. Clin Radiol. 1982; 33(4): 379-387. doi: 10.1016/S0009-9260(82)80301-2

Kitaguchi Y, Fujimoto K, Hanaoka M, Kawakami S, Honda T, Kubo K. Clinical characteristics of combined pulmonary fi-brosis and emphysema. Respirology. 2010; 15(2): 265-271. doi: 10.1111/j.1440-1843.2009.01676.x

American Thoracic Society. Guidelines for the six-minute walk test. Consensus statement. Am J Respir Crit Care Med. 2002; 166:111-117. doi: 10.1164/rccm.166/1/111

Papakosta D, Pitsiou G, Daniil Z, et al. Prevalence of pulmo-nary hypertension in patients with idiopathic pulmonary fibrosis: correlation with physiological parameters. Lung. 2011; 189(5): 391-399. doi: 10.1007/s00408-011-9304-5

Kimura M, Taniguchi H, Kondoh Y, et al. Pulmonary hyper-tension as a prognostic indicator at the initial evaluation in id-iopathic pulmonary fibrosis. Respiration. 2013; 85(6): 456-463. doi: 10.1159/000345221

Hamada K, Nagai S, Tanaka S, et al. Significance of pulmo-nary arterial pressure and diffusion capacity of the lung as prog-nosticators in patients with idiopathic pulmonary fibrosis. Chest. 2007; 131(3): 650-656. doi: 10.1378/chest.06-1466

Leuchte HH, Neurohr C, Baumgartner R, et al. Brain natri-uretic peptide and exercise capacity in lung fibrosis and pulmo-nary hypertension. Am J Respir Crit Care Med. 2004; 170(4): 360-365. doi: 10.1164/rccm.200308-1142OC

Leuchte HH, Baumgartner RA, Nounou ME, et al. Brain na-triuretic peptide is a prognostic parameter in chronic lung dis-ease. Am J Respir Crit Care Med. 2006; 173(7): 744-750. doi: 10.1164/rccm.200510-1545OC

Kinder BW, Brown KK, McCormack FX, et al. Serum sur-factant protein-A is a strong predictor of early mortality in idio-pathic pulmonary fibrosis. Chest. 2009; 135(6): 1557-1563. doi: 10.1378/chest.08-2209

Takahashi H, Fujishima T, Koba H, et al. Serum surfac-tant proteins A and D as prognostic factors in idiopathic pulmo-nary fibrosis and their relationship to disease extent. Am J Respir Crit Care Med. 2000; 162(3 Pt 1): 1109-1114. doi: 10.1164/ajrc-cm.162.3.9910080

Yokoyama A, Kondo K, Nakajima M, et al. Prognostic value of circulating KL-6 in idiopathic pulmonary fibrosis. Respirology. 2006; 11(2): 164-168. doi: 10.1111/j.1440-1843.2006.00834.x

Travis WD, Costabel U, Hansell DM, et al. An Official Amer-ican Thoracic Society/European Respiratory Society Statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013; 188(6): 733-748. doi: 10.1164/rccm.201308-1483ST

Rivera-Lebron BN, Forfia PR, Kreider M, Lee JC, Holmes JH, Kawut SM. Echocardiographic and hemodynamic predic-tors of mortality in idiopathic pulmonary fibrosis. Chest. 2013; 144(2): 564-570. doi: 10.1378/chest.12-2298

Todd NW, Jeudy J, Lavania S, et al. Centrilobular em-physema combined with pulmonary fibrosis results in im-proved survival. Fibrogenesis Tissue Repair. 2011; 4(1): 6. doi: 10.1186/1755-1536-4-6

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Published

2016-04-20

How to Cite

Yasuo Kitamura, Mitsuo Otsuka, Gen Yamada, Satoshi Yuda, Keiki Yokoo, Kimiyuki Ikeda, … Hiroki Takahashi. (2016). Serial Measurements of Tricuspid Regurgitation Pressure Gradient by Echocardiography Predict Prognosis in Idiopathic Pulmonary Fibrosis. Pulmonary Research and Respiratory Medicine, 3(1), 2–9. https://doi.org/10.17140/PRRMOJ-3-124

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Vol. 3 No. 1 (2016): Volume 3 Issue 1 2016

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