A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension

Abstract

These findings suggest that comprehensive risk assessments and the aim of reaching a low-risk profile are valid in PAH.

Pulmonary arterial hypertension: tailoring treatment to risk in the current era

“…This was compared with 21.2% in the high-risk cohort [16]. The Swedish PAH register study evaluated newly diagnosed patients who initiated PAH therapies and who had a multiparameter risk assessment performed both at baseline and at a follow-up assessment (median 4 months after baseline) [17]. For patients categorised as low risk at baseline and at follow-up, the 3-year survival rate was 98%.…”

“…For patients categorised as low risk at baseline and at follow-up, the 3-year survival rate was 98%. In contrast, for patients who were in the intermediate-or high-risk categories at baseline and remained in these groups at follow-up, the 3-year survival rate was only 68% [17]. A study from the French registry demonstrated clearly that in order to achieve a better long-term prognosis, patients need to have as many parameters as possible in the low-risk category.…”

Assessing risk in pulmonary arterial hypertension: what we know, what we don't

“…In the Swedish PAH registry (SPAHR), KYLHAMMAR et al [13] showed that in PAH incident patients, the "low risk" silo at baseline (n=530) and within 1-year follow-up (n=383), confers a survival advantage. Risk assessment variables in this work included functional class (FC), 6-min walk distance (6MWD), NT-proBNP, right atrial (RA) area; mean RA pressure (mRAP), pericardial effusion, cardiac index (CI), and mixed-venous oxygen saturation (SvO 2 ).…”

“…The selected cohort from COMPERA was a treatment-naïve, newly diagnosed PAH population with at least two of the following variables available: World Health Organization (WHO) FC, 6MWD, BNP or NT-proBNP, mRAP, CI and SvO 2 . Importantly, HOEPER et al [14] used a similar set of variables (minus mRAP and pericardial effusion) and a similar grading strategy as KYLHAMMAR et al [13] (risk silo was defined by a mean grade obtained by dividing the sum of all grades by the number of available variables).…”

“…Methodologically, in an effort to simplify risk prediction, both the expert derived ESC/ERS risk table and the current risk prediction analyses examining its "real world" applicability, share a major limitation. Common to all three analyses, the risk assessment tool employed is based on consensus of expert opinion rather than statistical modelling of validated parameters of risk [12,13]. In addition, these analyses did not cover the full spectrum of PAH subgroups nor, in some cases, all ages [13].…”