In:
Respiration, S. Karger AG, Vol. 96, No. 3 ( 2018), p. 249-258
Abstract:
〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Right ventricular (RV) dysfunction is a major prognostic predictor in pulmonary arterial hypertension (PAH). 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 The objective of this study was to assess the prognostic impact of a newly developed index merging haemodynamic parameters into 1 variable. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We retrospectively assessed 2 cohorts of 248 patients (164 from Hamburg and 84 from Heidelberg) with invasively diagnosed PAH. During a median follow-up time of 3.6 years (3.1 and 4.0 years for Hamburg and Heidelberg, respectively), the composite endpoint of all-cause mortality and lung transplantation occurred in 57 patients (53 and 4 patients for Hamburg and Heidelberg, respectively). The RV index was developed in the Hamburg cohort and validated in the Heidelberg cohort: (right atrial pressure × pulmonary vascular resistance)/mixed venous oxygen saturation. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Patients with a high RV index had a higher incidence of the combined endpoint in Kaplan-Meier analyses in the Hamburg and Heidelberg cohort ( 〈 i 〉 p 〈 /i 〉 = 0.017 and 〈 i 〉 p 〈 /i 〉 = 0.034, respectively). The calculated RV index cut-off value was 91 and identified patients with a worse outcome in the Hamburg cohort and showed a trend in the Heidelberg cohort ( 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001 and 〈 i 〉 p 〈 /i 〉 = 0.089, respectively). The RV index in Cox regression hazard models was an independent predictor of outcomes after adjustment for sex and age in both cohorts (Hamburg: hazard ratio [HR] 1.26 [95% CI 1.08, 1.47] , 〈 i 〉 p 〈 /i 〉 = 0.0027; Heidelberg: HR 2.27 [95% CI 1.46, 3.51], 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). A nomogram based on these results allowed risk stratification. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Merging 3 haemodynamic variables into 1 variable, the RV index increased the prognostic power up to an independent risk factor. The RV index is easy to calculate and allows the construction of a nomogram for an individualized risk assessment.
Type of Medium:
Online Resource
ISSN:
0025-7931
,
1423-0356
Language:
English
Publisher:
S. Karger AG
Publication Date:
2018
detail.hit.zdb_id:
1464419-8
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