RT Journal Article
SR Electronic
T1 A pragmatic approach to risk assessment in pulmonary arterial hypertension using the 2015 European Society of Cardiology/European Respiratory Society guidelines
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e001725
DO 10.1136/openhrt-2021-001725
VO 8
IS 2
A1 Fabio Dardi
A1 Alessandra Manes
A1 Daniele Guarino
A1 Elisa Zuffa
A1 Alessandro De Lorenzis
A1 Ilenia Magnani
A1 Mariangela Rotunno
A1 Alberto Ballerini
A1 Gerardo Vito Lo Russo
A1 Elena Nardi
A1 Nazzareno Galiè
A1 Massimiliano Palazzini
YR 2021
UL http://openheart.bmj.com/content/8/2/e001725.abstract
AB Objective To optimise treatment of patients with pulmonary arterial hypertension (PAH), the 2015 European Society of Cardiology/European Respiratory Society guidelines recommend using risk stratification, with the aim of patients achieving low-risk status. Previous analyses of registries made progress in using risk stratification approaches, however, the focus is often on patients with a low-risk prognosis, whereas most PAH patients are in intermediate-risk or high-risk categories. Using only six parameters with high prognostic relevance, we aimed to demonstrate a pragmatic approach to individual patient risk assessment to discriminate between patients at low risk, intermediate risk and high risk of death.Methods Risk assessment was performed combining six parameters in four criteria: (1) WHO functional class, (2) 6 min walk distance, (3) N-terminal pro-brain natriuretic peptide (BNP)/BNP plasma levels or right atrial pressure and (4) cardiac index or mixed venous oxygen saturation. Assessments were made at baseline and at first follow-up after 3–4 months.Results 725 PAH treatment-naive patients were analysed. Survival estimates between risk groups were statistically significant at baseline and first follow-up (p<0.001), even when the analysis was performed within PAH etiological subgroups. Similar results were observed in 208 previously treated PAH patients. Furthermore, patients who remained at or improved to low risk had a significantly better estimated survival compared with patients who remained at or worsened to intermediate risk or high risk (p≤0.005).Conclusion The simplified risk-assessment method can discriminate idiopathic, connective-tissue-disease-associated and congenital-heart-disease-associated PAH patients into meaningful high-risk, intermediate-risk and low-risk groups at baseline and first follow-up. This pragmatic approach reinforces targeting a low-risk profile for PAH patients.Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. All provided data included in the article cannot be traced back to individuals that participated in the study.