Risk stratification, prognosis, and survival in a pulmonary arterial hypertension cohort in Latin America. A multicenter study - 06/06/23

Doi : 10.1016/j.resmer.2022.100945

Mirta Diez ^a,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.},}^{^{2
These authors share first authorship}}, Jorge Cáneva ^b,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.},}^⁎,^{^{2
These authors share first authorship}} , Ana Diez ^c,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Eduardo R. Perna ^d,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Daniel Aimone ^e,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Martin Bosio ^f,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Lilia Lobo Márquez ^g,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Daniela García Brasca ^h,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Norberto Vulcano ^i,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Fernando Daghero ^j,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Lucrecia María Burgos ^a,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Liliana Favaloro ^b,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Juan Pablo Escalante ^c,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, María Lorena Coronel ^d,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Ayelén Fernández ^e,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Ángel Chávez ^k,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}, Lucrecia Secco ^k,^{^{1
This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.}}
on behalf of
START Investigators
^a Instituto Cardiovascular de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
^b Hospital Universitario Fundación Favaloro, Ciudad Autónoma de Buenos Aires, Argentina
^c Instituto Cardiovascular de Rosario, Rosario, Argentina
^d Instituto Cardiovascular de Corrientes, Corrientes, Argentina
^e Hospital El Cruce, Provincia de Buenos Aires, Argentina
^f Hospital Británico de Buenos Aires, Buenos Aires, Argentina
^g Instituto de Cardiología, San Miguel de Tucumán, Argentina
^h Hospital Italiano de Córdoba, Córdoba, Argentina
ⁱ Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
^j Sanatorio Allende, Córdoba, Argentina
^k Medical Affairs, Bayer Pharmaceuticals, Munro, Argentina

^⁎Corresponding author at: Institution Hospital Universitario Fundación Favaloro, Address Av. Belgrano 1782. 3rd Floor C1093AAS, Buenos Aires, Argentina.Institution Hospital Universitario Fundación FavaloroAddress Av. Belgrano 1782. 3rd FloorBuenos AiresC1093AASArgentina

Abstract

Background

Pulmonary arterial hypertension (PAH) guidelines suggest that achieving a low-risk profile should be the treatment goal. Our aim was to assess a risk assessment strategy based on three non-invasive variables from the ESC/ERS 2015 guidelines in a Latin American cohort.

Methods

92 incident patients (mean [SD] age 47, 77% female, 53% idiopathic PAH) were included in this retrospective, multicenter study. Patients were stratified at baseline and at early follow-up, within the first year, using three non-invasive variables (WHO functional class, 6-minute walking distance, BNP/NT-proBNP) from the ESC/ERS 2015 risk assessment instrument. Median (IQR) follow-up was 3.11 years (3.01 years).

Results

At baseline assessment, 25% of patients were at low risk, 61.9% at intermediate-risk, and 13% at high-risk. At early follow-up (median 9.5 months), 56.5% of patients were at low-risk, 40.2% at intermediate-risk, and 3.2% at high-risk (p<0.001 vs. baseline). According to risk stratification at early follow-up, one, three and five-year overall survival was 100% in the low-risk group (no deaths at five-year follow-up), and 100%, 84% (95% CI: 72–98%), and 66% (95% CI: 48–90%) respectively in the intermediate-risk group, p = 0.0003. Mortality in the high-risk patients at early follow-up was 1/3 (33.3%). One, three, and five-year event-free survival (death or transplant or first hospitalization due to worsening PAH) based on early follow-up risk assessment was higher in the low-risk group, p = 0.0003.

Conclusion

Our study validates a risk assessment strategy based on three non-invasive variables and confirms that early achievement of a low-risk profile should be the treatment goal.

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Keywords : Hypertension, Pulmonary, Risk assessment, Survival, clinical worsening, Treatment goal

Plan

Introduction

Methods

Study design and population

Risk stratification and study objectives

Regulatory, quality, and ethical considerations

Statistical analysis

Results

Patient population and baseline risk stratification

Treatment

Follow-up risk stratification

Overall survival, transplant, and hospitalizations for worsening PAH

Survival based on risk stratification at baseline and follow-up

Survival based on four-strata risk stratification at follow-up

Discussion

Conclusion

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Vol 83

Article 100945- juin 2023 Retour au numéro

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Risk stratification, prognosis, and survival in a pulmonary arterial hypertension cohort in Latin America. A multicenter study - 06/06/23

Abstract

Background

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Plan

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