A pragmatic approach to risk assessment in pulmonary arterial hypertension using the 2015 European Society of Cardiology/European Respiratory Society guidelines

• DOI: 10.1136/openhrt-2021-001725
• Publication Date: 2021-10-19T21:30:57Z
• Authors: Fabio Dardi; Alessandra Manes; Daniele Guarino; Elisa Zuffa; Alessandro De Lor...; Ilenia Magnani; Mariangela Rotunno; Alberto Ballerini; Gerardo Vito Lo R...; Elena Nardi; Nazzareno Galiè; Massimiliano Pala...
• Keywords: Adult; Time Factors; Adolescent; Cardiology; Risk Assessment; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Natriuretic Peptide, Brain; Diseases of the circulatory (Cardiovascular) system; Humans; Registries; Societies, Medical; Aged; Retrospective Studies; Pulmonary Vascular Disease; Pulmonary Arterial Hypertension; Incidence; Middle Aged; Prognosis; hypertension; pulmonary; pulmonary arterial hypertension; risk factors; 3. Good health; Europe; Oxygen Saturation; RC666-701; Biomarkers; Follow-Up Studies

ObjectiveTo optimise treatment of patients with pulmonary arterial hypertension (PAH), the 2015 European Society of Cardiology/European Respiratory Society guidelines recommend using risk stratification, with the aim of patients achieving low-risk status. Previous analyses of registries made progress in using risk stratification approaches, however, the focus is often on patients with a low-risk prognosis, whereas most PAH patients are in intermediate-risk or high-risk categories. Using only six parameters with high prognostic relevance, we aimed to demonstrate a pragmatic approach to individual patient risk assessment to discriminate between patients at low risk, intermediate risk and high risk of death.MethodsRisk assessment was performed combining six parameters in four criteria: (1) WHO functional class, (2) 6 min walk distance, (3) N-terminal pro-brain natriuretic peptide (BNP)/BNP plasma levels or right atrial pressure and (4) cardiac index or mixed venous oxygen saturation. Assessments were made at baseline and at first follow-up after 3–4 months.Results725 PAH treatment-naive patients were analysed. Survival estimates between risk groups were statistically significant at baseline and first follow-up (p<0.001), even when the analysis was performed within PAH etiological subgroups. Similar results were observed in 208 previously treated PAH patients. Furthermore, patients who remained at or improved to low risk had a significantly better estimated survival compared with patients who remained at or worsened to intermediate risk or high risk (p≤0.005).ConclusionThe simplified risk-assessment method can discriminate idiopathic, connective-tissue-disease-associated and congenital-heart-disease-associated PAH patients into meaningful high-risk, intermediate-risk and low-risk groups at baseline and first follow-up. This pragmatic approach reinforces targeting a low-risk profile for PAH patients.