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Predicting adverse events in patients with pulmonary arterial hypertension: The REVEAL Risk Score 2.0 and ESC/ERS-Based Risk Assessment Strategies
Session:
Painel 10 - Doença Valvular 8
Speaker:
Ana Rita Pereira
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Ana Rita F. Pereira; Maria José Loureiro; Filipa Ferreira; João Grade Santos; Débora Repolho; Helder Pereira
Abstract
<p><strong>Introduction: </strong>Pulmonary arterial hypertension (PAH) is a progressive, fatal disease. Current guidelines recommend patient assessment with the goal of achieving or maintaining low-risk status. Various strategies are validated to determine it. The most recently published was REVEAL 2.0 risk score (<em>CHEST</em> 2019; 156:323-337).</p> <p><strong>Aims:</strong> To assess the predictive value of the available risk scores in a Portuguese population with PAH.</p> <p><strong>Methods:</strong> Retrospective study including consecutive treatment-naïve patients (pts) newly diagnosed with PAH in a referral centre from 2007 to 2019. Clinical, echocardiographic and haemodynamic data at baseline were collected. Risk stratification was obtained using the REVEAL 2.0 score and ESC/ERS-based risk strategies: COMPERA score (<em>Eur Respir J</em> 2017;50:17000740) and FPHR score (<em>Eur Respir J</em> 2017;50:1700889). Adverse events were a composite of cardiovascular (CV) death and unplanned heart failure (HF) admission. Receiver operating characteristic (ROC) curves and area under curve (AUC) were used to compare scores.</p> <p><strong>Results:</strong> 60 pts were included: mean age 45.5 ± 7.8 years, 73.7% female. Idiopathic (28.3%) and congenital heart disease (30%) were the most common subtypes. At diagnosis, 95% of pts had limitation in daily physical activities (WHO functional class ≥ II), mean pulmonary arterial pressure was 46.5 ± 2.1 mmHg and pulmonary vascular resistance 9.9 ± 2.5 uWood. Clinical follow-up was complete in 95% of pts (median time 97.3 months). Adverse events occurred in 43.3% of cases: CV death rate 23.3%, unplanned HF admission rate 41.7%. Pts experiencing adverse events had lower cardiac index (2.1 ± 0.5 versus 2.5 ± 0.7 L/min/m<sup>2</sup>, p = 0.04), higher values of NTproBNP (3052.8 versus 747 pg/mL, p < 0.01) and lower walked distance in 6-minute walking test (315.6 ± 121.9 versus 401.6 ± 113.9 meters, p = 0.01) at baseline. Multivariate logistic regression identified 2 independent predictors (both protective) of adverse events: baseline low-risk status assessed by REVEAL 2.0 (OR 0.27, 95%CI 0.1-0.8, p = 0.02) or by FPHR scores (OR 0.32, 95%CI 0.1-0.9, p = 0.04). According ROC curves (figure 1), the REVEAL 2.0 score had significantly greater discrimination power (AUC 0.71, p < 0.01) than COMPERA (AUC 0.55, p = 048) and FPHR (AUC 0.62, p = 0.09).</p> <p><strong>Conclusions: </strong>This study helped to validate the multidimensional approach to risk assessment in pts with PAH. Low-risk status at baseline was predictive of better long-term prognosis. Recently published REVEAL 2.0 score demonstrated greater risk discrimination and have potential to become a fundamental tool in treatment decision of PAH pts.</p>
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