Abstract

BackgroundThe objective of this study was to analyze prognostic factors and risk stratification in patients with pulmonary arterial hypertension (PAH) and comorbidities.MethodsPatients 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.ResultsIn 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).ConclusionRisk 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 registrationNot applicable, retrospective registry.

Highlights

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

  • Risk stratification based on European Society of Cardiology (ESC)/European Respiratory Society (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

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Summary

Introduction

The objective of this study was to analyze prognostic factors and risk stratification in patients with pulmonary arterial hypertension (PAH) and comorbidities. Current registries selected risk parameters that define a low-, intermediate- and high-risk group and demonstrated the feasibility and validity of this approach [2,3,4,5,6,7,8] According to these and further publications the strategy of risk stratification as basis for treatment decisions has been maintained within the last World Symposium on Pulmonary Hypertension in Nice 2018 [9]. These patients may respond differently to PAH targeted therapies and initial monotherapy might be appropriate [9] Patients with this condition are often diagnosed at an advanced age (> 75 years) and carry at least three additional risk factors for left heart failure with preserved left ventricular ejection fraction such as high systemic blood pressure, diabetes mellitus, coronary artery disease, atrial fibrillation or obesity [9]

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