Performance of risk stratification scores and role of comorbidities in older vs younger patients with pulmonary arterial hypertension.

Humans Aged Pulmonary Arterial Hypertension / epidemiology Hypertension, Pulmonary Familial Primary Pulmonary Hypertension Risk Factors Registries Risk Assessment
comorbidities old pulmonary arterial hypertension risk stratification scores young

Journal

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
ISSN: 1557-3117
Titre abrégé: J Heart Lung Transplant
Pays: United States
ID NLM: 9102703

Informations de publication

Date de publication:
08 2023
Historique:
received: 27 08 2022
revised: 27 01 2023
accepted: 28 02 2023
medline: 7 8 2023
pubmed: 3 4 2023
entrez: 2 4 2023
Statut: ppublish

Résumé

Risk scores are important tools for the prognostic stratification of pulmonary arterial hypertension (PAH). Their performance and the additional impact of comorbidities across age groups is unknown. Patients with PAH enrolled from 2001 to 2021 were divided in ≥65 years old vs <65 years old patients. Study outcome was 5-year all-cause mortality. French Pulmonary Hypertension Network (FPHN), FPHN noninvasive, Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) and Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL 2.0) risk scores were calculated and patients categorized at low, intermediate and high risk. Number of comorbidities was calculated. Among 383 patients, 152 (40%) were ≥65 years old. They had more comorbidities (number of comorbidities 2, IQR 1-3, vs 1, IQR 0-2 in <65 years patients). Five-year survival was 63% in ≥65 vs 90% in <65 years. Risk scores correctly discriminated the different classes of risk in the overall cohort and in the older and younger groups. REVEAL 2.0 showed the best accuracy in the total cohort (C-index 0.74, standard error-SE- 0.03) and older (C-index 0.69, SE 0.03) patients, whereas COMPERA 2.0 performed better in younger patients (C-index 0.75, SE 0.08). Number of comorbidities was associated with higher 5-year mortality, and consistently increased the accuracy of risk scores, in younger but not in older patients. Risk scores have similar accuracy in the prognostic stratification of older vs younger PAH patients. REVEAL 2.0 had the best performance in older patients and COMPERA 2.0 had it in younger patients. Comorbidities increased the accuracy of risk scores only in younger patients.

Sections du résumé

BACKGROUND
Risk scores are important tools for the prognostic stratification of pulmonary arterial hypertension (PAH). Their performance and the additional impact of comorbidities across age groups is unknown.
METHODS
Patients with PAH enrolled from 2001 to 2021 were divided in ≥65 years old vs <65 years old patients. Study outcome was 5-year all-cause mortality. French Pulmonary Hypertension Network (FPHN), FPHN noninvasive, Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) and Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL 2.0) risk scores were calculated and patients categorized at low, intermediate and high risk. Number of comorbidities was calculated.
RESULTS
Among 383 patients, 152 (40%) were ≥65 years old. They had more comorbidities (number of comorbidities 2, IQR 1-3, vs 1, IQR 0-2 in <65 years patients). Five-year survival was 63% in ≥65 vs 90% in <65 years. Risk scores correctly discriminated the different classes of risk in the overall cohort and in the older and younger groups. REVEAL 2.0 showed the best accuracy in the total cohort (C-index 0.74, standard error-SE- 0.03) and older (C-index 0.69, SE 0.03) patients, whereas COMPERA 2.0 performed better in younger patients (C-index 0.75, SE 0.08). Number of comorbidities was associated with higher 5-year mortality, and consistently increased the accuracy of risk scores, in younger but not in older patients.
CONCLUSIONS
Risk scores have similar accuracy in the prognostic stratification of older vs younger PAH patients. REVEAL 2.0 had the best performance in older patients and COMPERA 2.0 had it in younger patients. Comorbidities increased the accuracy of risk scores only in younger patients.

Identifiants

DOI: 10.1016/j.healun.2023.02.1707 PMID: 37005100
pubmed: 37005100
pii: S1053-2498(23)01773-4
doi: 10.1016/j.healun.2023.02.1707
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1082-1092

Informations de copyright

Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Auteurs

Davide Stolfo (D)

Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: davide.stolfo@gmail.com.

Davide Barbisan (D)

Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy.

Pietro Ameri (P)

Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy.

Carlo Mario Lombardi (CM)

Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.

Simonetta Monti (S)

Cardiology and Pneumology Division, Fondazione Toscana G. Monasterio, Pisa, Italy; Institute of Clinical Physiology (IFC)-CNR, Pisa, Italy.

Mauro Driussi (M)

Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.

Isabella Carlotta Zovatto (IC)

Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy.

Piero Gentile (P)

De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.

Luke Howard (L)

Imperial College London, Faculty of Medicine, National Heart & Lung Institute, London, UK; National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK.

Matteo Toma (M)

Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy.

Matteo Pagnesi (M)

Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.

Valentino Collini (V)

Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy; Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.

Carolina Bauleo (C)

Cardiology and Pneumology Division, Fondazione Toscana G. Monasterio, Pisa, Italy.

Giulia Guglielmi (G)

Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy.

Marianna Adamo (M)

Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.

Luciana D'Angelo (L)

De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.

Chiara Nalli (C)

Cardiac Surgery, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.

Paolo Sciarrone (P)

Cardiology and Pneumology Division, Fondazione Toscana G. Monasterio, Pisa, Italy.

Martina Moschella (M)

Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.

Barbara Zorzi (B)

Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy; National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK.

Veronica Vecchiato (V)

Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy.

Martina Milani (M)

Università degli Studi di Milano-Bicocca, Milano, Italy.

Emma Di Poi (E)

Rheumatology Clinic, Department of Medicine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.

Edoardo Airò (E)

Cardiology and Pneumology Division, Fondazione Toscana G. Monasterio, Pisa, Italy.

Marco Metra (M)

Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.

Andrea Garascia (A)

De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.

Gianfranco Sinagra (G)

Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy.

Francesco Lo Giudice (F)

National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Performance of risk stratification scores and...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Performance of risk stratification scores and...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Maladies pulmonaires › Hypertension artérielle pulmonaire › Performance of risk stratification scores and...
questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Hypertension artérielle › Hypertension pulmonaire › Performance of risk stratification scores and...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Maladies pulmonaires › Hypertension artérielle pulmonaire primitive familiale › Performance of risk stratification scores and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Performance of risk stratification scores and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enregistrements › Performance of risk stratification scores and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Appréciation des risques › Performance of risk stratification scores and...