Predictive Power of Pulmonary Artery Stiffness-Right Ventricular Interplay, But Not Pulmonary Vascular Resistance, in Mild Pulmonary Hypertension: A PVRI GoDeep Meta-Registry Analysis.
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Yogeswaran Athiththan, Fünderich Meike, Kiely David G, Annis Jeffrey S, Brittain Evan, Bogaard Harm Jan, Balasubramanian Aparna, Hassoun Paul M, Howard Luke, Lawrie Allan, Wilkins Martin R, Thenappan Thenappan, Elwing Jean, Jose Arun, Lichtblau Mona, Ulrich Silvia, Harbaum Lars, Klose Hans, Sweatt Andrew J, Zamanian Roham T, Lau Edmund M, Kuronuma Keiichiro, Matsubara Hiromi, Dwyer Nathan, Sirenko Yuriy, Torbas Olena, Eichstaedt Christina A, Grünig Ekkehard, Lavender Melanie, Arvanitaki Alexandra, Giannakoulas George, Frauendorf Marlize, Williams Paul G, Zhai Zhenguo, Zhang Zhu, Anthi Anastasia, Dima Effrosyni, Sabbour Hani, Saleh Khaled, Ghio Stefano, Scelsi Laura, De Luque Figueroa Juliana, Orozco-Levi Mauricio, Ramirez-Sarmiento Alba, Sivakumaran Siva, Anderson James, Chan Stephen Y, King Ingrid, Olschewski Horst, Ghofrani Hossein-Ardeschir, Grimminger Friedrich, Majeed Raphael W, Wilhelm Jochen, Tello Khodr, Seeger Werner, PVRI GoDeep Consortium
Аннотация
RESEARCH QUESTION: Do PAC, Ea, and SVI predict mortality independently of PVR in patients with mild pulmonary hypertension (PH) and across the full spectrum of PH?
STUDY DESIGN AND METHODS: Using the international PVRI GoDeep meta-registry, we first evaluated the prognostic relevance of PAC, Ea, and SVI in patients with mild PH, defined as a mPAP > 20 mm Hg and < 25 mm Hg. Subsequently, these analyses were extended to the overall PH population across the full spectrum of disease severity. Subgroup analyses were performed according to PH etiology. PAC was calculated as the ratio of stroke volume to pulmonary arterial pulse pressure, and Ea as end-systolic pressure divided by stroke volume.
RESULTS: In patients with mild PH (n = 1,097), neither mPAP nor PVR predicted mortality (both P > .05). In contrast, Ea, PAC, SVI, and heart rate demonstrated independent prognostic value. Expanding the analysis to 16,899 patients across PH groups 1-5, these parameters remained significantly associated with survival, independent of PVR/total pulmonary resistance and after adjustment for multiple potential confounders. Consistent findings were observed across etiological subgroups and idiopathic pulmonary arterial hypertension/heritable pulmonary arterial hypertension.
INTERPRETATION: Parameters integrating pulsatile vascular load and interdependent RV function possess predictive power independent of PVR/total pulmonary resistance across the full spectrum of PH. Moreover, they allow meaningful risk stratification in patients with mild PH, for whom conventional parameters lack discriminative prognostic power.
CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT05329714; URL: www.
CLINICALTRIALS: gov.