PROGNOSTIC STRATIFICATION ROLE OF STROKE VOLUME INDEX IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION AT INTERMEDIATE RISK

Abstract

TYPE: Abstract TOPIC: Pulmonary Vascular Disease PURPOSE: Current guidelines stratify the risk of pulmonary arterial hypertension (PAH) patients with a multiparametric approach. This risk assessment and a simplified risk table have been recently proposed and validated. However, most patients are classified in the intermediate risk category. We evaluate the prognostic value of stroke volume index (SVI) to further stratify intermediate-risk patients. METHODS: 621 treatment naïve patients with PAH referred to a single Centre were assessed were assessed at baseline and at the first 3-4 months follow-up after starting PAH-specific therapy with right heart catheterization, brain natriuretic peptide plasma levels, 6-min walking distance and WHO functional class. We applied the simplified risk assessment strategy recently validated in the Bologna cohort of patients. We assessed the prognostic value of SVI using Cox regression analysis and we considered the value of SVI that best discriminate prognosis to discriminate intermediate risk patients at follow-up into intermediate-low and intermediate-high risk. RESULTS: SVI is an independent predictor of prognosis in intermediate-risk PAH patients at first follow-up. The value of SVI that best discriminate prognosis is 35 ml/m2 (AUC 0.63; sensitivity 58%; specificity 68%). This value is able to discriminate intermediate risk patients at follow-up into intermediate-low and intermediate-high risk patients that have a significantly different prognosis (p-value= 0.010). CONCLUSIONS: SVI assessed at first follow-up is predictive of prognosis and the cut-point value of 35 ml/m2 is able to further stratify the survival of intermediate risk PAH patients. CLINICAL IMPLICATIONS: SVI should be used to further stratify intermediate-risk PAH patients after first-line treatment to tailor the potency of triple sequential combination therapy needed. DISCLOSURE: Nothing to declare. KEYWORD: stroke volume index