Prognostic role of haemodynamics at follow-up in patients with pulmonary arterial hypertension: a challenge to current European Society of Cardiology/European Respiratory Society risk tools.

Background

Haemodynamic variables like right atrial pressure (RAP), cardiac index (CI), stroke volume index (SVI) and mixed venous oxygen saturation (

Methods

This cohort study includes treatment-naïve patients assessed at baseline and after first-line PAH therapy with clinical, functional, exercise, laboratory and haemodynamic evaluations. Using a stepwise multivariate Cox regression analysis, independent prognostic haemodynamic parameters were identified and stratified according to cut-offs already defined in the European Society of Cardiology (ESC)/European Respiratory Society (ERS) risk table or defined based on the highest Chi-squared of the log-rank test. Their discriminatory power was tested for all-cause death and a combined end-point of death, hospitalisation and need of treatment escalation.

Results

794 patients with PAH were enrolled. At first follow-up, RAP and pulmonary artery elastance were independently associated with death. Because of high correlations between haemodynamic parameters, different multivariable analyses were done identifying six other variables (pulmonary arterial compliance, cardiac efficiency, pulmonary vascular resistance,

Conclusion

Haemodynamics' discriminative ability for clinical worsening is comparable to current ESC/ERS risk tools and is of added value to non-invasive parameters.

Informations de copyright

Copyright ©The authors 2024.

Déclaration de conflit d'intérêts

Conflict of interest: F. Dardi reports consulting fees from Janssen and Chiesi Farmaceutici, and lecture fees from Janssen, in the past 36 months. Conflict of interest: D. Guarino has nothing to disclose. Conflict of interest: A. Ballerini has nothing to disclose. Conflict of interest: R. Bertozzi has nothing to disclose. Conflict of interest: F. Donato has nothing to disclose. Conflict of interest: F. Cennerazzo has nothing to disclose. Conflict of interest: M. Salvi has nothing to disclose. Conflict of interest: E. Nardi has nothing to disclose. Conflict of interest: I. Magnani has nothing to disclose. Conflict of interest: A. Manes participated on the TASC advisory board for Janssen in the past 36 months. Conflict of interest: N. Galiè reports consulting and lecture fees from Janssen and Ferrer in the past 36 months. Conflict of interest: M. Palazzini reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events, and support for attending meetings and/or travel from Janssen, in the past 36 months.