Prognostic role of haemodynamics at follow-up in patients with pulmonary arterial hypertension: a challenge to current ESC/ERS risk tools

Abstract

Hemodynamic variables like right atrial pressure (RAP), cardiac index (CI), stroke volume index (SVI) and mixed venous oxygen saturation (SvO2) predict survival in patients with pulmonary arterial hypertension (PAH). However, there is the need to identify further prognostic haemodynamic parameters as well as to redefine their role in PAH risk stratification compared to current risk tools and non-invasive parameters.this cohort-study includes treatment-naïve patients assessed at baseline and after first line PAH therapy with clinical, functional, exercise, laboratory, and haemodynamic evaluations. Using a stepwise multivariate Cox regression analysis, independent prognostic haemodynamic parameters were identified and stratified according to cut-offs already defined in the ESC/ERS risk table or defined based on the highest chi2 of the log-rank test. Their discriminatory power was tested for all-cause death and a combined endpoint of death, hospitalization and need of treatment escalation.794 patients with PAH were enrolled. At first follow-up, RAP and pulmonary artery elastance were independently associated with death. Because of high correlations different multivariable analyses were done identifying other six variables (pulmonary arterial compliance, cardiac efficiency, pulmonary vascular resistance, SvO2, CI and SVI). Haemodynamic parameters were of no added prognostic value compared to ESC/ERS risk tools for the all-cause death endpoint, but, for the combined endpoint, are of added value to non-invasive parameters and, when taken alone, had a discriminatory capacity comparable to ESC/ERS risk tools.haemodynamics discriminative-ability for clinical worsening is comparable to current ESC/ERS risk tools and is of added value to non-invasive parameters.