Which finding combination indicates poor prognosis in pulmonary hypertension?

Which finding combination indicates poor prognosis in pulmonary hypertension?

• A. LV dilation with reduced EF.
• B. Left atrial enlargement with preserved RV function.
• C. Aortic root dilation.
• D. RV dilation, reduced TAPSE, reduced RV global/free-wall strain, septal flattening toward the LV, and IVC dilation.

Answer: (D)

In pulmonary hypertension, the key determinant of outcome is how well the right ventricle tolerates the increased afterload. When the RV can compensate, function remains relatively preserved; when it cannot, a cascade of signs emerges on echocardiography that signals a poor prognosis. The combination described reflects advanced right heart failure due to pressure overload. RV dilation shows the chamber enlarging under high afterload. Reduced TAPSE indicates diminished longitudinal systolic function of the RV, a sensitive marker of RV contractile impairment. Reduced RV global and free-wall strain reveals worse myocardial deformation and overall RV systolic mechanics. Septal flattening toward the LV demonstrates interventricular interaction from elevated RV pressures, causing the septum to bow into the LV and further compromise LV filling and function. IVC dilation signals elevated right atrial pressure and systemic venous congestion. Taken together, these findings point to a decompensated RV with poor prognosis in pulmonary hypertension.

In pulmonary hypertension, the key determinant of outcome is how well the right ventricle tolerates the increased afterload. When the RV can compensate, function remains relatively preserved; when it cannot, a cascade of signs emerges on echocardiography that signals a poor prognosis.

The combination described reflects advanced right heart failure due to pressure overload. RV dilation shows the chamber enlarging under high afterload. Reduced TAPSE indicates diminished longitudinal systolic function of the RV, a sensitive marker of RV contractile impairment. Reduced RV global and free-wall strain reveals worse myocardial deformation and overall RV systolic mechanics. Septal flattening toward the LV demonstrates interventricular interaction from elevated RV pressures, causing the septum to bow into the LV and further compromise LV filling and function. IVC dilation signals elevated right atrial pressure and systemic venous congestion. Taken together, these findings point to a decompensated RV with poor prognosis in pulmonary hypertension.