Pneumologie 2020; 74(S 01): 123
DOI: 10.1055/s-0039-3403344
Freie Vorträge (FV13) – Sektion Kardiorespiratorische Interaktion
Freie Vorträge der Sektion Kardiorespiratorische Interaktion
Georg Thieme Verlag KG Stuttgart · New York

Risk stratification and prognostic factors in pulmonary arterial Hypertension and pulmonary arterial Hypertension with comorbidities

P Xanthouli
1   Centre for Pulmonary Hypertension at Thoraxklinik at University Hospital; Translational Lung Research Centre Heidelberg (Tlrc), German Centre for Lung Research (Dzl)
,
M Koegler
1   Centre for Pulmonary Hypertension at Thoraxklinik at University Hospital; Translational Lung Research Centre Heidelberg (Tlrc), German Centre for Lung Research (Dzl)
,
N Benjamin
1   Centre for Pulmonary Hypertension at Thoraxklinik at University Hospital; Translational Lung Research Centre Heidelberg (Tlrc), German Centre for Lung Research (Dzl)
,
L Fischer
1   Centre for Pulmonary Hypertension at Thoraxklinik at University Hospital; Translational Lung Research Centre Heidelberg (Tlrc), German Centre for Lung Research (Dzl)
,
B Egenlauf
1   Centre for Pulmonary Hypertension at Thoraxklinik at University Hospital; Translational Lung Research Centre Heidelberg (Tlrc), German Centre for Lung Research (Dzl)
,
C Eichstaedt
1   Centre for Pulmonary Hypertension at Thoraxklinik at University Hospital; Translational Lung Research Centre Heidelberg (Tlrc), German Centre for Lung Research (Dzl)
,
S Harutyunova
1   Centre for Pulmonary Hypertension at Thoraxklinik at University Hospital; Translational Lung Research Centre Heidelberg (Tlrc), German Centre for Lung Research (Dzl)
,
AM Marra
2   Centre for Pulmonary Hypertension at Thoraxklinik at University Hospital, Heidelberg; Irccs Sdn, Naples, Italy
,
C Nagel
3   Centre for Pulmonary Hypertension at Thoraxklinik at University Hospital, Heidelberg; Translational Lung Research Centre Heidelberg (Tlrc), German Centre for Lung Research (Dzl); Lung Centre, Klinikum Mittelbaden, Baden-Baden Balg
,
V Theobald
1   Centre for Pulmonary Hypertension at Thoraxklinik at University Hospital; Translational Lung Research Centre Heidelberg (Tlrc), German Centre for Lung Research (Dzl)
,
E Grünig
1   Centre for Pulmonary Hypertension at Thoraxklinik at University Hospital; Translational Lung Research Centre Heidelberg (Tlrc), German Centre for Lung Research (Dzl)
› Author Affiliations
Further Information

Publication History

Publication Date:
28 February 2020 (online)

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Background: The current guidelines for pulmonary arterial hypertension (PAH) propose risk stratification into three groups using clinical parameters and the estimated one-year survival. This study sought to analyse whether this risk stratification is also useful in patients with PAH and comorbidities.

Methods: In this study patients with invasively diagnosed PAH with or without comorbidities were included. Uni- and multivariate analysis were employed for identification of factors predicting survival and time to first clinical worsening (TTCW) in both groups. Risk stratification parameters included 6-minute walking distance (6MWD), right atrial (RA) area, WHO-functional class (FC) and NTproBNP.

Results: In total 150 patients were enrolled into the study, 8 were excluded due to missing values. Of the remaining 142 patients 90 were diagnosed as PAH without and 52 with comorbidities. All patients received targeted PAH therapy and were followed for 3.3 ± 2.4 years. According to the ESC/ERS risk stratification survival and TTCW were significantly associated with reduced 6MWD (p = 0.019; p = 0.031), elevated NTproBNP (p = 0.032; p = 0.002), WHO-FC (p = 0.016; p = 0.079) and RA area (p = 0.013; p = 0.034) in the univariate Cox Regression analysis in PAH without comorbidities. In the multivariate analysis, 6MWD was an independent predictor for survival (p = 0.002) and WHO-FC for TTCW (p = 0.001). These parameters had no significant association with survival and TTCW in PAH with comorbidities. Average risk score was significantly associated with survival (p = 0.001) and TTCW (p = 0.013) in PAH but not in PAH with comorbidities (both p > 0.05; [Fig. 1]).

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Fig. 1 

Conclusion: Risk stratification based on ESC/ERS-guidelines could only be confirmed in patients without comorbidities but not in patients with PAH and comorbidities. The data of this study suggest, that a different risk stratification needs to be applied to PAH patients with comorbidities. Further studies are needed to confirm these results.