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Risk stratification in Pulmonary arterial hypertension: do our patients benefit from a 4-strata model?
Session:
Comunicações Orais (Sessão 28) - Cardiopatias Congénitas, Doença Vascular Pulmonar e Embolia Pulmonar 3 - Vários Tópicos
Speaker:
Bárbara Marques Ferreira
Congress:
CPC 2022
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; Alexandra Briosa; Ana Rita Pereira; Débora Repolho; João Grade Santos; Mariana Martinho; Diogo Cunha; Maria José Loureiro; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">Background:</span></span></span></strong><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e"> Risk stratification plays an essential role in the management of patients with pulmonary arterial hypertension (PAH). The current European guidelines propose a 3-strata model to categorize risk as low, intermediate, or high, based on the expected 1-year mortality. However, with this model, most patients are categorized as intermediate risk. A recent publication purposed a refined risk assessment model for PAH based on 4 risk categories (low, intermediate-low, intermediate-high and high risk), based in simple and non-invasive measures like functional class (FC), 6-minute walking distance (6MWD) and NTproBNP.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">Objective:</span></span></span></strong><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e"> To analyze the prognostic impact of further risk substratification in intermediate-low and intermediate high in patients with PAH.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">Methods: </span></span></span></strong><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">Retrospective longitudinal study that included all patients with pulmonary arterial hypertension (PAH) followed in a referral center. Uncorrected complex congenital heart disease and Eisenmenger physiology were excluded. Baseline data was collected to calculate patient risk using COMPERA risk score. Intermediate risk group was subdivided using refined cut-off values into intermediate-low (FC I-II; 6MWD 320-440 m; NTproBNP 300-649 ng/L) or intermediate-high (FC III, 6MWD 165-319 m; NTproBNP 650-1100 ng/L). Adverse events during follow-up included initiation of parenteric prostanoid therapy, referral for lung transplantation and death. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e">Results:</span></span></span></strong><span style="font-size:11.5pt"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#201f1e"> The cohort included 75 patients (82.1% female, mean age at diagnosis 47.4</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">17.6 years</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">). Baseline characteristics: WHO Functional class I/II/III/IV 2.7%/25.3%/54.7%/17.3%, respectively; 6MWD 386.7±128.7m, cardiac index 2.26±0.64 L/min/m2, mean pulmonary vascular resistance 11.54±5.60 WoodsU (Table 1).</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><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 COMPERA risk score, 23% of the patients were at low risk, 62.2% on intermediate risk and 14.9% at high risk. Substratification of the 46 pts in the intermediate-risk category based on the mentioned methodology identified 22 pts (47.8%) in the intermediate-low and 26 pts (52.2%) in the intermediate-high risk categorie. Mean COMPERA risk score using 4 strata for this pts was 2.022</span></span></span><span style="font-size:11.5pt"><span style="font-family:Symbol"><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">0.39 and 3.04</span></span></span><span style="font-size:11.5pt"><span style="font-family:Symbol"><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">0.39, respectively. Baseline clinical differences between the 4 risk groups are represented in table 1. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><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">The Kaplan-Meier survival analysis (Figure 1) revealed worse outcome for pts in intermediate-high compared to intermediate-low risk: log-rank 0.019; HR 0,382 (0,16-0,89).</span></span></span></span></span></p> <p style="text-align:justify"><strong><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"> In pts with PAH further risk stratification of intermediate risk group into intermediate-high and intermediate-low using refined cut-offs for FC, 6MWT and NTproBNP, can identify patients at higher risk of adverse events. This pts might benefit from a more aggressive upfront combination therapy at the time of diagnosis.</span></span></span></p>
Slides
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