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

Stefano Ghio, Michele D'Alto, Roberto Badagliacca, Patrizio Vitulo, Paola Argiento, Massimiliano Mulè, Fabio Tuzzolino, Laura Scelsi, Emanuele Romeo, Claudia Raineri, Lavinia Martino, Corrado Tamburino, Roberto Poscia, Carmine Dario Vizza

Research output: Contribution to journalArticle

Abstract

Background 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. Methods A 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. Results After 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%). Conclusions In 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.
Original languageEnglish
Pages (from-to)53-58
Number of pages6
JournalInternational Journal of Cardiology
Volume230
DOIs
Publication statusPublished - Mar 1 2017

Fingerprint

Lung Compliance
Pulmonary Hypertension
Cardiac Catheterization
Therapeutics
Hemodynamics
Systemic Scleroderma
ROC Curve
Area Under Curve
Multivariate Analysis
Sensitivity and Specificity
Survival

Keywords

  • Prognosis
  • Pulmonary arterial hypertension
  • Right heart hemodynamics

Cite this

Prognostic relevance of pulmonary arterial compliance after therapy initiation or escalation in patients with pulmonary arterial hypertension. / Ghio, Stefano; D'Alto, Michele; Badagliacca, Roberto; Vitulo, Patrizio; Argiento, Paola; Mulè, Massimiliano; Tuzzolino, Fabio; Scelsi, Laura; Romeo, Emanuele; Raineri, Claudia; Martino, Lavinia; Tamburino, Corrado; Poscia, Roberto; Vizza, Carmine Dario.

In: International Journal of Cardiology, Vol. 230, 01.03.2017, p. 53-58.

Research output: Contribution to journalArticle

Ghio, Stefano ; D'Alto, Michele ; Badagliacca, Roberto ; Vitulo, Patrizio ; Argiento, Paola ; Mulè, Massimiliano ; Tuzzolino, Fabio ; Scelsi, Laura ; Romeo, Emanuele ; Raineri, Claudia ; Martino, Lavinia ; Tamburino, Corrado ; Poscia, Roberto ; Vizza, Carmine Dario. / Prognostic relevance of pulmonary arterial compliance after therapy initiation or escalation in patients with pulmonary arterial hypertension. In: International Journal of Cardiology. 2017 ; Vol. 230. pp. 53-58.
@article{dce2ccad739141bba7108be51f51081c,
title = "Prognostic relevance of pulmonary arterial compliance after therapy initiation or escalation in patients with pulmonary arterial hypertension",
abstract = "Background 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. Methods A 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. Results After 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{\%}). Conclusions In 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.",
keywords = "Prognosis, Pulmonary arterial hypertension, Right heart hemodynamics",
author = "Stefano Ghio and Michele D'Alto and Roberto Badagliacca and Patrizio Vitulo and Paola Argiento and Massimiliano Mul{\`e} and Fabio Tuzzolino and Laura Scelsi and Emanuele Romeo and Claudia Raineri and Lavinia Martino and Corrado Tamburino and Roberto Poscia and Vizza, {Carmine Dario}",
year = "2017",
month = "3",
day = "1",
doi = "10.1016/j.ijcard.2016.12.099",
language = "English",
volume = "230",
pages = "53--58",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Prognostic relevance of pulmonary arterial compliance after therapy initiation or escalation in patients with pulmonary arterial hypertension

AU - Ghio, Stefano

AU - D'Alto, Michele

AU - Badagliacca, Roberto

AU - Vitulo, Patrizio

AU - Argiento, Paola

AU - Mulè, Massimiliano

AU - Tuzzolino, Fabio

AU - Scelsi, Laura

AU - Romeo, Emanuele

AU - Raineri, Claudia

AU - Martino, Lavinia

AU - Tamburino, Corrado

AU - Poscia, Roberto

AU - Vizza, Carmine Dario

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Background 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. Methods A 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. Results After 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%). Conclusions In 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.

AB - Background 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. Methods A 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. Results After 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%). Conclusions In 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.

KW - Prognosis

KW - Pulmonary arterial hypertension

KW - Right heart hemodynamics

U2 - 10.1016/j.ijcard.2016.12.099

DO - 10.1016/j.ijcard.2016.12.099

M3 - Article

VL - 230

SP - 53

EP - 58

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -