Blood carbon dioxide tension and risk in pulmonary arterial hypertension

Harbaum, Lars; Fuge, Jan; Kamp, Jan C.; Hennigs, Jan K.; Simon, Marcel; Sinning, Christoph; Oqueka, Tim; Grimminger, Jan; Olsson, Karen M.; Hoeper, Marius M.; Klose, Hans

doi:10.1016/j.ijcard.2020.06.069

Cited by 15 publications

(18 citation statements)

References 25 publications

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“…Partial pressure of arterial carbon dioxide (PaCO 2 ) is typically lower than normal due to alveolar hyperventilation [79]. Low PaCO 2 at diagnosis and follow-up is common in PAH and associated with unfavourable outcomes [80]. Elevated PaCO 2 is very unusual in PAH and reflects alveolar hypoventilation, which in itself may be a cause of PH.…”

Section: Electrocardiogrammentioning

confidence: 99%

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Humbert

Kovàcs²,

Hoeper³

et al. 2022

Eur Respir J

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Section: Electrocardiogrammentioning

confidence: 99%

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Humbert

Kovàcs²,

Hoeper³

et al. 2022

Eur Respir J

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1,030

1,631

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“…In these patients, a more granular risk prediction is required, in particular for far-reaching therapeutic decisions including the need for parenteral prostanoid therapy and evaluation for lung transplantation. Several investigators have shown that the use of additional variables derived from echocardiography, right heart catheterization or blood gas analysis improved risk prediction [11][12][13][14]. As an alternative model, the SPAHR group recently proposed a modification of their original approach defining a calculated score of 1.5-1.99 as intermediate-low risk and a score of 2.0-2.4 as intermediate-high risk [15].…”

Section: Introductionmentioning

confidence: 99%

COMPERA 2.0: a refined four-stratum risk assessment model for pulmonary arterial hypertension

et al. 2021

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BackgroundRisk stratification plays an essential role in the management of patients with pulmonary arterial hypertension (PAH). The current European guidelines propose a 3-strata model to categorise risk as low, intermediate, or high, based on the expected 1-year mortality. However, with this model, most patients are categorised as intermediate risk. We investigated a modified approach based on 4 risk categories with intermediate risk subdivided into intermediate-low and intermediate-high risk.MethodsWe analysed data from COMPERA, a European pulmonary hypertension registry, and calculated risk at diagnosis and first follow-up based on functional class (FC), 6 min walking distance (6 MWD) and serum levels of brain natriuretic peptide (BNP) or N-terminal fragment of pro-BNP (NT-proBNP), using refined cut-off values. Survival was assessed with Kaplan-Meier analyses, log-rank testing, and Cox proportional hazards models.ResultsData from 1,655 patients with PAH were analysed. Using the 3-strata model, most patients were classified as intermediate risk (76.0% at baseline and 63.9% at first follow-up). The refined 4-strata risk model yielded a more nuanced separation and predicted long-term survival, especially at follow-up assessment. Changes in risk from baseline to follow-up were observed in 31.1% of the patients with the 3-strata model and in 49.2% with the 4-strata model. These changes, including those between the intermediate-low and intermediate-high strata, were associated with changes in long-term mortality risk.ConclusionsModified risk stratification using a 4-strata model based on refined cut-off levels for FC, 6MWD and BNP/NT-proBNP was more sensitive to prognostically relevant changes in risk than the original 3-strata model.

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“…Lewis et al reported an increase in c-statistic of the REVEAL 2.0 calculator from 0.74 (0.65–0.83) to 0.78 (0.70–0.87) upon addition of the right ventricular end-systolic volume index. Harbaum et al ( 43 ) increased the c-statistic of the COMPERA model from 0.62 (0.52–0.73) to 0.67 (0.57–0.79) by adding arterial carbon dioxide partial pressure to the model. Addition of biomarkers NT-proBNP and endostatin to the FPHR invasive method was shown to increase the c-statistic from 0.62 to 0.72 ( 35 ), and endostatin also increased the c-statistic of the FPHR non-invasive method from 0.68 to 0.71 ( 35 ).…”

Section: Resultsmentioning

confidence: 99%

“…A possible approach for improving risk stratification models may be the addition of new parameters. The increase of the c-statistic in all enhancement studies, except for the addition of arterial carbon dioxide partial pressure to the FPHR non-invasive model ( 43 ), shows that the predictive strength of risk stratification models can be improved by adding imaging or serum biomarkers. Of all the enhancement studies, the addition of the right ventricular end-systolic volume index seems most promising ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Risk stratification in adult and pediatric pulmonary arterial hypertension: A systematic review

Lokhorst

Werf

Berger

et al. 2022

Front. Cardiovasc. Med.

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IntroductionCurrently, risk stratification is the cornerstone of determining treatment strategy for patients with pulmonary arterial hypertension (PAH). Since the 2015 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines for the diagnosis and treatment of pulmonary hypertension recommended risk assessment, the number of studies reporting risk stratification has considerably increased. This systematic review aims to report and compare the variables and prognostic value of the various risk stratification models for outcome prediction in adult and pediatric PAH.MethodsA systematic search with terms related to PAH, pediatric pulmonary hypertension, and risk stratification was performed through databases PubMed, EMBASE, and Web of Science up to June 8, 2022. Observational studies and clinical trials on risk stratification in adult and pediatric PAH were included, excluding case reports/series, guidelines, and reviews. Risk of bias was assessed using the Prediction model Risk Of Bias Assessment Tool. Data on the variables used in the models and the predictive strength of the models given by c-statistic were extracted from eligible studies.ResultsA total of 74 studies were eligible for inclusion, with this review focusing on model development (n = 21), model validation (n = 13), and model enhancement (n = 9). The variables used most often in current risk stratification models were the non-invasive WHO functional class, 6-minute walk distance and BNP/NT-proBNP, and the invasive mean right atrial pressure, cardiac index and mixed venous oxygen saturation. C-statistics of current risk stratification models range from 0.56 to 0.83 in adults and from 0.69 to 0.78 in children (only two studies available). Risk stratification models focusing solely on echocardiographic parameters or biomarkers have also been reported.ConclusionStudies reporting risk stratification in pediatric PAH are scarce. This systematic review provides an overview of current data on risk stratification models and its value for guiding treatment strategies in PAH.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022316885], identifier [CRD42022316885].

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Blood carbon dioxide tension and risk in pulmonary arterial hypertension

Cited by 15 publications

References 25 publications

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

COMPERA 2.0: a refined four-stratum risk assessment model for pulmonary arterial hypertension

Risk stratification in adult and pediatric pulmonary arterial hypertension: A systematic review

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