Prediction of Prognostic Hemodynamic Indices in Pulmonary Hypertension Using Non-Invasive Parameters

Abstract

Effective targeted therapy of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) requires regular risk stratification. Among many prognostic parameters, three hemodynamic indices: right atrial pressure, cardiac index, and mixed venous saturation are considered critically important for correct risk classification. All of them are measured invasively and require right heart catheterization (RHC). The study was aimed to verify assumption that a model based on non-invasive parameters is able to predict hemodynamic profile described by the mentioned invasive indices. A group of 330 patients with pulmonary hypertension was used for the selection of the best predictors from the set of 17 functional, biochemical, and echocardiographic parameters. Multivariable logistic regression models for the prediction of low-risk and high-risk profiles were created. The cut-off points were determined and subsequent validation of the models was conducted prospectively on another group of 136 patients. The ROC curve analysis showed the very good discrimination power of the models (AUC 0.80–0.99) in the prediction of the hemodynamic profile in the total validation group and subgroups: PAH and CTEPH. The models indicated the risk profiles with moderate sensitivity (57–60%) and high specificity (87–93%). The method enables estimation of the hemodynamic indices when RHC cannot be performed.

Clinical value of echocardiography in evaluating hemodynamics and right ventricular function in patients with chronic thromboembolic pulmonary hypertension after balloon pulmonary angioplasty

“…to estimate right ventricular function, which were more consistent with invasive measurements compared with the univariate analysis results (26). Sixth, the influence of BPA complications, such as post-reperfusion pulmonary edema, on the obtained measurement results was not factored during analysis.…”

Echocardiographic evaluation of the right atrial size and function: Relevance for clinical practice

“…Right atrial pressure (RAP) is a hemodynamic variable that provides crucial diagnostic and prognostic information in both cardiovascular and pulmonary disease patients [25] , [26] , [27] , [28] , [29] . Reference standard RAP is measured employing right heart catheterization, but right heart catheterization is unsuitable for regular serial assessment.…”

Dual-Energy CT Pulmonary Angiography for the Assessment of Surgical Accessibility in Patients with Chronic Thromboembolic Pulmonary Hypertension

“…However, this Jamieson classification scheme Diagnostics 2022, 12, 228 2 of 13 is based on intraoperative findings and there are limited reports on its correlation with preoperative imaging [9,10]. Patients deemed inoperable based on comorbidities, or with extensive distal disease not accessible to surgery, may be candidates for medical therapy and/or balloon pulmonary angioplasty but these therapies are not curative [1,11].…”