Raymond et al identified a number of factors predictive of a poor outcome for a patient with primary pulmonary hypertension. These can help to identify a patient who may benefit from more aggressive management. The authors are from Duke University, University of Washington in Seattle, Maine Medical Center, Washington University, Rhode Island Hospital and Louisiana State University.


Patient selection: primary pulmonary hypertension


Evaluation: echocardiography


Endpoints: death or heart transplantation


Echocardiographic predictors of an adverse outcome:

(1) pericardial effusion

(2) enlarged right atrium


Clinical predictors of a poor prognosis:

(1) reduced 6 minute walk test (< 500 feet, or < 152 meters)

(2) lower oxygen saturation in mixed venous blood

(3) delay in starting appropriate medical therapy (prostacyclin, etc)

(4) NYHA functional class IV


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