Risk assessment was performed combining six parameters in four criteria: (1) WHO functional class, (2) 6 min walk distance, (3) N-terminal pro-brain natriuretic peptide (BNP)/BNP plasma levels or right atrial pressure and (4) cardiac index or mixed venous oxygen saturation. Assessments were made at baseline and at first follow-up after 3-4 months.
725 PAH treatment-naive patients were analysed. Survival estimates between risk groups were statistically significant at baseline and first follow-up (p<0.001), even when the analysis was performed within PAH etiological subgroups. Similar results were observed in 208 previously treated PAH patients. Furthermore, patients who remained at or improved to low risk had a significantly better estimated survival compared with patients who remained at or worsened to intermediate risk or high risk (p≤0.005).
The simplified risk-assessment method can discriminate idiopathic, connective-tissue-disease-associated and congenital-heart-disease-associated PAH patients into meaningful high-risk, intermediate-risk and low-risk groups at baseline and first follow-up. This pragmatic approach reinforces targeting a low-risk profile for PAH patients.
结合四个标准中的六个参数进行风险评估:(1)WHO功能类别,(2)6分钟步行距离,(3)N末端脑钠肽前体(BNP)/BNP血浆水平或右心房压力和(4)心脏指数或混合静脉血氧饱和度。在基线和3-4个月后的首次随访时进行评估。
分析了725例未经PAH治疗的患者。风险组之间的生存估计在基线和首次随访时具有统计学意义(p<0.001),即使在PAH病因亚组内进行分析.在208名先前治疗的PAH患者中观察到类似的结果。此外,与保持处于中危或高危或恶化的患者相比,保持处于低危或改善至低危的患者的估计生存期显著更好(p≤0.005).
简化的风险评估方法可以区分特发性,结缔组织疾病相关和先天性心脏病相关的PAH患者进入有意义的高风险,基线和首次随访时的中危和低危人群.这种务实的方法加强了PAH患者的低风险特征。