Abstract
Background: The prognostic value of hemodynamic variables after treatment initiation in pulmonary arterial hypertension (PAH) is not well established. Methods: We evaluated incident patients between 2006-2016 with idiopathic, drug and toxin-induced or heritable PAH who had a follow-up right heart catheterization (RHC). The primary outcome was death or lung transplantation. We used stepwise Cox regression and receiver operating characteristic (ROC) analysis to assess variables at first follow-up RHC Results: Of 763 patients, death or transplantation occurred in 211 (27.7%) over a median follow-up time of 3.2 years (IQR25-75% 1.61-5.13). Median time to first follow-up RHC was 4.6 months (IQR 3.7-7.8). Multivariate predictors at first follow-up RHC were: age, male gender, idiopathic PAH, New York Heart Association functional class, 6-minute walk distance, stroke volume index (SVI), and right atrial pressure (RAP). Adjusted hazard ratios for hemodynamic variables were: SVI 0.975 (95%CI 0.961-0.989, p Conclusions: Stroke volume index and right atrial pressure at first follow-up catheterization were the best hemodynamic predictors of death or transplantation. These variables should be further validated as treatment targets in a prospective study.
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