Incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertension
Abstract Risk assessment for pulmonary arterial hypertension (PAH) utilizing noninvasive prognostic variables could be more practical in real‐world scenarios, especially at follow‐up reevaluations. Patients who underwent comprehensive evaluations both at baseline and at follow‐up visits were enrolle...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-10-01
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| Series: | Pulmonary Circulation |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/pul2.12158 |
| _version_ | 1797975737833095168 |
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| author | Ruilin Quan Xiaoxi Chen Tao Yang Wen Li Yuling Qian Yangyi Lin Changming Xiong Guangliang Shan Qing Gu Jianguo He |
| author_facet | Ruilin Quan Xiaoxi Chen Tao Yang Wen Li Yuling Qian Yangyi Lin Changming Xiong Guangliang Shan Qing Gu Jianguo He |
| author_sort | Ruilin Quan |
| collection | DOAJ |
| description | Abstract Risk assessment for pulmonary arterial hypertension (PAH) utilizing noninvasive prognostic variables could be more practical in real‐world scenarios, especially at follow‐up reevaluations. Patients who underwent comprehensive evaluations both at baseline and at follow‐up visits were enrolled. The primary endpoint was all‐cause mortality. Predictive variables identified by Cox analyses were further incorporated with the French noninvasive risk prediction approach. A total of 580 PAH patients were enrolled. During a median follow‐up time of 47.0 months, 112 patients (19.3%) died. By multivariate Cox analyses, tricuspid annular plane systolic excursion (TAPSE), TAPSE/pulmonary arterial systolic pressure (PASP), and cardiopulmonary exercise testing‐derived peak oxygen consumption (VO2) remained independent predictors for survival. Regarding the French noninvasive risk prediction method, substituting N‐terminal pro‐b‐type natriuretic peptide (NT‐proBNP) with the newly derived low‐risk criteria of a TAPSE ≥ 17 mm or a TAPSE/PASP > 0.17 mm/mmHg, or alternating 6‐min walking distance with a peak VO2 ≥ 44 %predicted retained the discrimination power. When recombining the low‐risk criteria, the combination of World Health Organization functional class (WHO FC), TAPSE and peak VO2 at baseline, and the combination of WHO FC, NT‐proBNP, and peak VO2 at follow‐up showed better discriminative ability than the other combinations. In conclusion, Peak VO2, TAPSE, and TAPSE/PASP are significant prognostic predictors for survival in PAH, with incremental prognostic value when incorporated with the French noninvasive risk prediction approach, especially at reevaluations. For better risk prediction, WHO FC, at least one measurement of exercise capacity and one measurement of right ventricular function should be considered. |
| first_indexed | 2024-04-11T04:40:10Z |
| format | Article |
| id | doaj.art-5b9d8092a04a43b987ebfc415c3e0b06 |
| institution | Directory Open Access Journal |
| issn | 2045-8940 |
| language | English |
| last_indexed | 2024-04-11T04:40:10Z |
| publishDate | 2022-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Pulmonary Circulation |
| spelling | doaj.art-5b9d8092a04a43b987ebfc415c3e0b062022-12-28T07:32:41ZengWileyPulmonary Circulation2045-89402022-10-01124n/an/a10.1002/pul2.12158Incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertensionRuilin Quan0Xiaoxi Chen1Tao Yang2Wen Li3Yuling Qian4Yangyi Lin5Changming Xiong6Guangliang Shan7Qing Gu8Jianguo He9Department of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People's Republic of ChinaDepartment of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People's Republic of ChinaDepartment of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People's Republic of ChinaDepartment of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People's Republic of ChinaDepartment of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People's Republic of ChinaDepartment of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People's Republic of ChinaDepartment of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People's Republic of ChinaDepartment of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences Beijing People's Republic of ChinaDepartment of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People's Republic of ChinaDepartment of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing People's Republic of ChinaAbstract Risk assessment for pulmonary arterial hypertension (PAH) utilizing noninvasive prognostic variables could be more practical in real‐world scenarios, especially at follow‐up reevaluations. Patients who underwent comprehensive evaluations both at baseline and at follow‐up visits were enrolled. The primary endpoint was all‐cause mortality. Predictive variables identified by Cox analyses were further incorporated with the French noninvasive risk prediction approach. A total of 580 PAH patients were enrolled. During a median follow‐up time of 47.0 months, 112 patients (19.3%) died. By multivariate Cox analyses, tricuspid annular plane systolic excursion (TAPSE), TAPSE/pulmonary arterial systolic pressure (PASP), and cardiopulmonary exercise testing‐derived peak oxygen consumption (VO2) remained independent predictors for survival. Regarding the French noninvasive risk prediction method, substituting N‐terminal pro‐b‐type natriuretic peptide (NT‐proBNP) with the newly derived low‐risk criteria of a TAPSE ≥ 17 mm or a TAPSE/PASP > 0.17 mm/mmHg, or alternating 6‐min walking distance with a peak VO2 ≥ 44 %predicted retained the discrimination power. When recombining the low‐risk criteria, the combination of World Health Organization functional class (WHO FC), TAPSE and peak VO2 at baseline, and the combination of WHO FC, NT‐proBNP, and peak VO2 at follow‐up showed better discriminative ability than the other combinations. In conclusion, Peak VO2, TAPSE, and TAPSE/PASP are significant prognostic predictors for survival in PAH, with incremental prognostic value when incorporated with the French noninvasive risk prediction approach, especially at reevaluations. For better risk prediction, WHO FC, at least one measurement of exercise capacity and one measurement of right ventricular function should be considered.https://doi.org/10.1002/pul2.12158cardiopulmonary exercise testingechocardiographypulmonary arterial hypertensionrisk predictionsurvival |
| spellingShingle | Ruilin Quan Xiaoxi Chen Tao Yang Wen Li Yuling Qian Yangyi Lin Changming Xiong Guangliang Shan Qing Gu Jianguo He Incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertension Pulmonary Circulation cardiopulmonary exercise testing echocardiography pulmonary arterial hypertension risk prediction survival |
| title | Incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertension |
| title_full | Incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertension |
| title_fullStr | Incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertension |
| title_full_unstemmed | Incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertension |
| title_short | Incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertension |
| title_sort | incorporation of noninvasive assessments in risk prediction for pulmonary arterial hypertension |
| topic | cardiopulmonary exercise testing echocardiography pulmonary arterial hypertension risk prediction survival |
| url | https://doi.org/10.1002/pul2.12158 |
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