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Abstract：
To optimise treatment of patients with pulmonary arterial hypertension (PAH), the 2015 European Society of Cardiology/European Respiratory Society guidelines recommend using risk stratification, with the aim of patients achieving low-risk status. Previous analyses of registries made progress in using risk stratification approaches, however, the focus is often on patients with a low-risk prognosis, whereas most PAH patients are in intermediate-risk or high-risk categories. Using only six parameters with high prognostic relevance, we aimed to demonstrate a pragmatic approach to individual patient risk assessment to discriminate between patients at low risk, intermediate risk and high risk of death.
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.
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.
摘要：
优化肺动脉高压（PAH）患者的治疗，2015年欧洲心脏病学会/欧洲呼吸学会指南推荐使用风险分层，目的是使患者达到低风险状态。以前对登记册的分析在使用风险分层方法方面取得了进展，然而,重点通常是低风险预后的患者，而大多数PAH患者属于中危或高危类别.仅使用六个具有高预后相关性的参数，我们的目的是展示一种务实的方法来评估个体患者的风险，以区分低风险患者，中等风险和高死亡风险。
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。
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。
