Incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertension

Abstract

Risk assessment for pulmonary arterial hypertension (PAH) utilizing noninvasive prognostic variables could be more practical in real-world scenarios, especially at follow-up reevaluations. Patients who underwent comprehensive evaluations both at baseline and at follow-up visits were enrolled. The primary endpoint was all-cause mortality. Predictive variables identified by Cox analyses were further incorporated with the French noninvasive risk prediction approach. A total of 580 PAH patients were enrolled. During a median follow-up time of 47.0 months, 112 patients (19.3%) died. By multivariate Cox analyses, tricuspid annular plane systolic excursion (TAPSE), TAPSE/pulmonary arterial systolic pressure (PASP), and cardiopulmonary exercise testing-derived peak oxygen consumption (VO 2 ) remained independent predictors for survival. Regarding the French noninvasive risk prediction method, substituting N-terminal pro-b-type natriuretic peptide (NT-proBNP) with the newly derived low-risk criteria of a TAPSE ≥ 17 mm or a TAPSE/PASP > 0.17 mm/mmHg, or alternating 6-min walking distance with a peak VO 2 ≥ 44 %predicted retained the discrimination power. When recombining the low-risk criteria, the combination of World Health Organization functional class (WHO FC), TAPSE and peak VO 2 at baseline, and the combination of WHO FC, NT-proBNP, and peak VO 2 at follow-up showed better discriminative ability than the other combinations. In

Prognostic Value of Serial Risk Stratification in Adult and Pediatric Pulmonary Arterial Hypertension: A Systematic Review

“…The predictive strength of the different risk models at follow‐up compared with baseline is shown in Figure 2 . 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 Overall, the C‐statistic at follow‐up was higher than at baseline. At follow‐up, it ranged from 0.66 to 0.91, with a median of 0.73 (IQR, 0.71–0.78), whereas at baseline, it ranged from 0.57 to 0.77, with a median of 0.67 (IQR, 0.65–0.69).…”

“…Because of the anomaly, these C‐statistics are not included in the above summary statistics. No differences in C‐statistic were observed between regions (Figure S1 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ). In addition to the REVEAL, SPAHR/COMPERA, and FPHR models, other combinations of variables have been investigated.…”

“…In addition to the REVEAL, SPAHR/COMPERA, and FPHR models, other combinations of variables have been investigated. For example, Quan et al 28 explored different combinations of WHO‐FC, NT‐proBNP, 6MWD, peak oxygen uptake percentage predicted, tricuspid annular plane systolic excursion/systolic pulmonary artery pressure, and tricuspid annular plane systolic excursion, with their highest C‐statistic (0.78) found for the combination of WHO‐FC, NT‐proBNP, and peak oxygen uptake percentage predicted.…”