Prognostic relevance of pulmonary arterial compliance after therapy initiation or escalation in patients with pulmonary arterial hypertension

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• 作者：Stefano Ghio^a ; ¹ ; ^{s.ghio@smatteo.pv.it} ; Michele D'Alto^b ; ¹ ; Roberto Badagliacca^c ; ¹ ; Patrizio Vitulo^d ; ¹ ; Paola Argiento^b ; ¹ ; Massimiliano Mulè ; ^e ; ¹ ; Fabio Tuzzolino^d ; ¹ ; Laura Scelsi^a ; ¹ ; Emanuele Romeo^b ; ¹ ; Claudia Raineri^a ; ¹ ; Lavinia Martino^d ; ¹ ; Corrado Tamburino^e ; ¹ ; Roberto Poscia^c ; ¹ ; Carmine Dario Vizza^c ; ¹
• 关键词：Pulmonary arterial hypertension ; Prognosis ; Right heart hemodynamics
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 March 2017
• 年：2017
• 卷：230
• 期：Complete
• 页码：53-58
• 全文大小：430 K
• 卷排序：230

文摘

Conventional hemodynamic parameters are considered to be the gold standard indices of outcome in pulmonary arterial hypertension (PAH); on the contrary, few data support the hypothesis that the pulsatile component of right ventricular afterload provides important prognostic information. The aim of the study was to investigate the prognostic significance of pulmonary arterial compliance (PCa) after therapy initiation or escalation in PAH patients.MethodsA cohort of 419 consecutive PAH patients (308 naive and 111 prevalent) underwent right heart catheterisation (RHC) prior to initiating or escalating PAH-targeted therapy. RHC was repeated in 255 patients (61%) after 4 to 12 months of therapy as 62 patients (15%) died and 102 (24%) did not undergo a follow-up RHC within the first year.ResultsAfter the follow-up RHC, 63 patients died over a median follow-up period of 39 months. At multivariate analysis, age > 50 years old, male gender, etiology associated with systemic sclerosis, persistence of WHO class III/IV, and reduced PCa at follow-up RHC were the independent parameters significantly associated with poor prognosis. At ROC analysis, the optimal cut-off point of PCa to predict survival was 1.4 mL/mmHg (AUC 0.73, sensitivity 81.8%, specificity 58.8%).ConclusionsIn PAH patients hospitalized to initiate or to escalate PAH-specific therapy, failure to improve PCa after therapy is a strong hemodynamic predictor of poor prognosis.