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Risk stratification refinements with inclusion of haemodynamic variables at follow-up in patients with pulmonary arterial hypertension.
Boucly, Athénaïs; Beurnier, Antoine; Turquier, Ségolène; Jevnikar, Mitja; de Groote, Pascal; Chaouat, Ari; Cheron, Céline; Jaïs, Xavier; Picard, François; Prévot, Grégoire; Roche, Anne; Solinas, Sabina; Cottin, Vincent; Bauer, Fabrice; Montani, David; Humbert, Marc; Savale, Laurent; Sitbon, Olivier.
Afiliação
  • Boucly A; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France.
  • Beurnier A; AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
  • Turquier S; INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
  • Jevnikar M; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.
  • de Groote P; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France.
  • Chaouat A; INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
  • Cheron C; AP-HP, Service de Physiologie et Explorations Fonctionnelles Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
  • Jaïs X; CHU de Lyon HCL, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, Groupement Hospitalier Est, Hôpital Louis Pradel, Bron, France.
  • Picard F; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France.
  • Prévot G; AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
  • Roche A; INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
  • Solinas S; Université de Lille, Service de Cardiologie, CHU Lille, Institut Pasteur de Lille, Inserm U1167, Lille, France.
  • Cottin V; INSERM UMR_S1116, Faculté de Médecine de Nancy, Université de Lorraine, Département de Pneumologie, CHRU de Nancy, Vandœuvre-lès-Nancy, France.
  • Bauer F; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France.
  • Montani D; AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
  • Humbert M; INSERM UMR_S999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
  • Savale L; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France.
  • Sitbon O; AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
Eur Respir J ; 64(3)2024 Sep.
Article em En | MEDLINE | ID: mdl-38663975
ABSTRACT

BACKGROUND:

Haemodynamic variables are prognostic factors in pulmonary arterial hypertension (PAH). However, right heart catheterisation (RHC) is not systematically recommended to assess the risk status during follow-up. This study aimed to assess the added value of haemodynamic variables in prevalent patients to predict the risk of death or lung transplantation according to their risk status assessed by the non-invasive four-strata model as recommended by the European guidelines.

METHODS:

We evaluated incident patients with PAH enrolled in the French pulmonary hypertension registry between 2009 and 2020 who had a first follow-up RHC. Cox regression identified, in each follow-up risk status, haemodynamic variables significantly associated with transplant-free survival. Optimal thresholds were determined by time-dependent receiver operating characteristics. Several multivariable Cox regression models were performed to identify the haemodynamic variables improving the non-invasive risk stratification model.

RESULTS:

We analysed 1240 incident patients reassessed within 1 year by RHC. None of the haemodynamic variables were significantly associated with transplant-free survival among low-risk (n=386) or high-risk (n=71) patients. Among patients at intermediate (intermediate-low, n=483 and intermediate-high, n=300) risk at first follow-up, multivariable models including either stroke volume index (SVI) or mixed venous oxygen saturation (S vO2 ) were the best. The prognostic performance of a refined six-strata risk stratification model including the non-invasive four-strata model and SVI >37 mL·m-2 and/or S vO2 >65% for patients at intermediate risk (area under the curve (AUC) 0.81; c-index 0.74) was better than that of the four-strata model (AUC 0.79, p=0.009; c-index 0.72).

CONCLUSION:

Cardiopulmonary haemodynamics may improve risk stratification at follow-up in patients at intermediate risk.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cateterismo Cardíaco / Hipertensão Arterial Pulmonar / Hemodinâmica Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Cateterismo Cardíaco / Hipertensão Arterial Pulmonar / Hemodinâmica Idioma: En Ano de publicação: 2024 Tipo de documento: Article