SPC365

Four strata risk stratification in pulmonary arterial hypertension: is it really enough?

Session: Sessão de Posters 06 - Hipertensão Pulmonar
Speaker: Bárbara Marques Ferreira

Congress: CPC 2024
Topic: I. Hypertension
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Cartazes
FP Number: ---
Authors: Bárbara Marques Ferreira; Filipa Ferreira; Ana Rita Pereira; Sofia Alegria; Débora Repolho; Mariana Martinho; Diogo Cunha; Nazar Ilchysnyn; João Luz; Oliveira Baltazar; Liliana Brochado; Hélder Pereira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Pulmonary arterial hypertension (PAH) treatment relies on risk stratification. Recently, the latest guidelines recommend employing a 4-strata risk stratification tool for follow-up, that is based in three accessible and non-invasive parameters: functional class, NT-proBNP or BNP levels, and 6-minute walking distance (6MWD).</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Objective:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Validation of the 4-strata risk stratification tool in our PAH population. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methodology:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Retrospective cohort that included all PAH patients (pts) being followed in a referral center since 2005 with complete dataset. Complex congenital heart disease and unrepaired congenital lesions were excluded from this analysis. All clinical data needed for risk stratification, based in the ESC Guidelines, were collected at baseline and 6-12 months after therapy. Adverse events until November 2023 were recorded and defined as: parenteral prostanoid therapy initiation (excluding the first 6 months), pulmonary transplant and death. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">We included 58 pts, 71% female, mean age 49.67&plusmn;16.04 years. Concerning etiology of PAH: 31% associated with connective tissue disease, 20.7% associated with HIV infection, 17.2% idiopathic, 12.1% associated with portal hypertension, 6.9% with features of venous/capillary involvement, 5.2% heritable, 5.2% associated with congenital heart disease, and 1.7% associated with drugs.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">At baseline, 15 pts (25.9%) were at low-risk, 36 (62.1%) at intermediate-risk, and 7 (12.1%) at high-risk. Detailed baseline characteristics can be found in <em>Table 1</em>. In the first 6 months, 22 pts (37.9%) underwent monotherapy, 27 (46.6%) initiated upfront combination therapy excluding prostanoids, and 8 (13.8%) combination therapy including parenteral prostanoid.</span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Based on classic 3-strata risk stratification tool, following 6-12 months of therapy, 41 pts (70%) were at low-risk, and 17 (29.3%) were at intermediate-risk. There were no high-risk pts. Risk reduction was achieved in 35 pts (60.3%), unaltered in 21 (36.2%), and increased in 3 (5.2%). </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Based on new 4-strata risk stratification tool, following 6-12 months of therapy, 21 pts (36.2%) were at low-risk, 21 (36.2%) at intermediate-low-risk, 13 (22.4%) at intermediate-high-risk, and 3 (5.2%) were at high risk. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Using Cox-regression analyses, this new 4-strata risk stratification tool proved to be a predictor of survival free from events. Adverse events were 4x and 6x higher in intermediate-high-risk and high-risk, respectively (p=0.014). The same did not happen with 3-strata risk stratification tool at baseline or 6-12 month after therapy. Survival Kaplan-Meier curves can be found in <em>Image 1</em>. </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">In our PAH population, 4-strata risk stratification tool was the best predictor for survival free from events when compared to the classic 3-strata multiparametric tool, where risk for adverse events seems to be underestimated.</span></span></p>