Interpretation:

Among patients with severe PPH, there is an association between adverse outcomes and the presence of pericardial effusion, RA dilation and septal displacement. This multi-center study of a relatively large number of patients with PPH confirms findings suggested by a number of smaller single center studies. The relationship of outcome to parameters suggesting advanced right heart pathology probably relates to a worsened outcome due to right heart failure. The presence of pericardial effusion probably represents right heart pathology impeding pericardial fluid drainage and does not relate to a hemodynamic effect of the effusion. These patients were evaluated as part of a randomized trial of prostacyclin versus conventional treatment, after which the majority of patients received continuous prostacyclin. Early randomization to prostacyclin was also associated with a better outcome, however the data are not further broken down by echocardiographic variables in the early versus delayed prostacyclin therapy groups. Inspection of the survival curves suggests that there was substantial early mortality in these patients, however the relationship of therapy to outcome cannot be elucidated from the data as presented. This study certainly would support the contention that patients with greater degrees of right heart pathology represent a high-risk subset of PPH patients for whom referral to specialized centers should be considered.