Risk Stratification and Prognostic Factors in Patients with Pulmonary Arterial Hypertension and Comorbidities a Cross-sectional Cohort Study with Survival Follow-up

Overview

Journal Respir Res

Specialty Pulmonary Medicine

Date 2020 May 26

PMID 32448256

Citations 11

Authors

Panagiota Xanthouli

Maria Koegler

Alberto M Marra

Nicola Benjamin

Lukas Fischer

Christina A Eichstaedt

Satenik Harutyunova

Christian Nagel

Ekkehard Grunig

Benjamin Egenlauf

Affiliations

Soon will be listed here.

Abstract

Background: The objective of this study was to analyze prognostic factors and risk stratification in patients with pulmonary arterial hypertension (PAH) and comorbidities.

Methods: Patients with invasively diagnosed PAH were included in the analysis. Comorbidities were clinically diagnosed as proposed in the 6th World Symposium of pulmonary hypertension. Uni- and multivariate analysis were employed for identification of factors predicting survival and time to first clinical worsening (TTCW). Risk stratification was based on parameters from ESC/ERS-guidelines 2015.

Results: In total 142 patients were enrolled in the study, 90 of them were diagnosed as PAH without and 52 with comorbidities. All patients received targeted PAH therapy and were followed for 3.3 ± 2.4 years. In PAH patients without comorbidities survival and TTCW were significantly associated with reduced 6-min walking distance (6MWD), elevated N-terminal pro brain natriuretic peptide (NT-proBNP), WHO-functional class (WHO-FC) and right atrial (RA) area. In the multivariate analysis, 6MWD was an independent predictor for survival (p = 0.002) and WHO-FC for TTCW (p = 0.001). In patients with PAH and comorbidities these parameters had no significant association with survival and TTCW. Average risk score was significantly associated with survival (p = 0.001) and TTCW (p = 0.013) in PAH but not in PAH with comorbidities (both p > 0.05; figure 1).

Conclusion: Risk stratification based on ESC/ERS-guidelines could only be confirmed in patients without comorbidities, but not in patients with PAH and comorbidities. The data of this study suggest, that a different risk stratification needs to be applied to PAH patients with comorbidities. Further studies are needed to confirm these results.

Trial Registration: Not applicable, retrospective registry.

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