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Comparison of Risk Scores calculators in patients newly diagnosed with pulmonary arterial hypertension
Session:
CO 19- Hipertensão Pulmonar
Speaker:
Bárbara Marques Ferreira
Congress:
CPC 2021
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:
Comunicações Orais
FP Number:
---
Authors:
Bárbara Marques Ferreira; Filipa Ferreira; Sofia Alegria; Débora Repolho; Ana Rita Pereira; João Grade Santos; Alexandra Briosa; Mariana Martinho; Ana Marques; Daniel Sebaiti; Ana Francisco; Otilia Simoes; Hélder Pereira
Abstract
<p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">Background: Pulmonary arterial hypertension (PAH) is a chronic, progressive, and incurable disease with significant morbidity and mortality. Comprehensive and accurate risk prediction is essential to make individualized treatment decisions and optimizing outcomes in PAH usually with multiparametric scores. The ESC/ERS risk stratification table is simple to approach. However, often patients have variables that fall into different risk categories at the same time point, limiting its “real-world” applicability. FPHN, COMPERA and REVEAL are multiparametric tools validated for risk stratification.</span></span></span></span></span></span></p> <p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">Objective: To better understand risk status determination in our PAH population and compare different risk score calculators.</span></span></span></span></span></span></p> <p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">Methods: Retrospective longitudinal study that included all patients with group I pulmonary hypertension (PAH). Uncorrected complex congenital heart disease and Eisenmenger physiology were excluded. Baseline data were collected to calculate patient risk using COMPERA, FPHN and REVEAL tools. Follow-up adverse events were registered and included parenteric prostanoid therapy, referral for lung transplant and death. </span></span></span></span></span></span></p> <p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">Results: The cohort comprised 67 patients (70% female, mean age at diagnosis 48</span></span></span><span style="font-size:11.5pt"><span style="font-family:"Cambria Math",serif"><span style="color:#201f1e">±</span></span></span><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">17). Baseline characteristics: WHO Functional class I/II -28,4%, III-56,7% and IV-14,9%; 6-min walk distance 395±125 m, cardiac index 2,26±0,61, mean PVR 11,83 WoodsU. </span></span></span></span></span></span><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">Using FPHN, COMPERA and REVEAL scores respectively, patients at low risk were 4,8%, 24% and 33%, at intermediate risk were 15,9%, 60% and 35% and at high-risk were 79,4%, 16% and 31%. </span></span></span></span></span></span><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">There was a slight agreement between the 3 scores (kappa value 0,125, p=0,034). </span></span></span></span></span></span><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">FPHN overestimated the risk compared to other scores. </span></span></span></span></span></span><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">With an average follow-up of 5 years 26 patients died (mortality 36%). </span></span></span></span></span></span><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">The Kaplan-Meier survival estimates (Fig.1) show that the REVEAL score provided better characterization of the risk of adverse events than either COMPERA or FPHN.</span></span></span></p> <p><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">CONCLUSION:</span></span></span><strong><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e"> </span></span></span></strong><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">REVEAL score was the best risk stratification tool to identify survival without adverse events in our patients with pulmonary arterial hypertension. COMPERA could also identify patients at risk. FPHN overestimated risk and had no discriminative power to risk stratification.</span></span></span></span></span></span></p>
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