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Risk Assessment and Survival of Pulmonary Hypertension Patients: Multicenter Experience in Turkey [Anatol J Cardiol]
Anatol J Cardiol. Ahead of Print: AJC-53498 | DOI: 10.14744/AnatolJCardiol.2019.53498  

Risk Assessment and Survival of Pulmonary Hypertension Patients: Multicenter Experience in Turkey

Yalın Tolga Yaylalı1, Ibrahim Başarıcı2, Burçak Kılıçkıran Avcı3, Murat Meriç4, Ümit Yaşar Sinan5, Hande Şenol6, Mehmet Serdar Küçükoğlu5, Zeki Öngen3
1Department Of Cardiology, Pamukkale University, Denizli, Turkey
2Department Of Cardiology, Akdeniz University, Antalya, Turkey
3Department Of Cardiology, Cerrahpaşa Faculty Of Medicine, Istanbul, Turkey
4Department Of Cardiology, Ondokuz Mayis University, Samsun, Turkey
5Department Of Cardiology, Istanbul University, Institute Of Cardiology, Istanbul, Turkey
6Department Of Biostatistics, Pamukkale University, Denizli, Turkey

BACKGROUND: Risk stratification continues to evolve in pulmonary arterial hypertension (PAH). We aimed to further confirm risk assessment strategy in our cohort and to determine the most reliable model.
METHODS: We enrolled incident patients with idiopathic PAH (IPAH), heritable, drug induced, congenital heart disease (CHD), connective tissue diseases (CTD) subsets, and chronic thromboembolic pulmonary hypertension (CTEPH) from January 2008 to February 2018. Data from baseline and subsequent follow-ups within 1 year of diagnosis were included. An abbreviated risk assessment strategy was applied, using the following variables: functional class (FC), 6-minute walk distance (6 MWD), N-terminal pro–brain natriuretic peptide (NT-proBNP) or BNP, right atrial (RA) area, pericardial effusion, mean right atrial pressure, cardiac index and mixed venous oxygen saturation. Three different methods were applied to categorize patients.
RESULTS: 189 subjects (46 ± 17 years, 23% male) were included. 61 patients had died. Survival differed significantly between the risk groups both at diagnosis and during follow-up. Patients with a low-risk profile had better survival. Abbreviated risk assessment tool predicted mortality at early follow-up in the entire group and CHD, CTD subsets, and CTEPH seperately. Overall mortality among risk categories was significantly different according to each categorization method. The most reliable model comprised FC, 6 MWD, NT pro-BNP/BNP, and RA area at follow up.
CONCLUSIONS: Abbreviated risk assessment tool may be valid for PAH subsets and CTEPH. Echocardiographic variables do matter. A model comprising FC, 6 MWD, NT pro-BNP/BNP, and RA area at follow up could be useful for better prognostication.

Keywords: chronic thromboembolic pulmonary hypertension, pulmonary arterial hypertension, pulmonary arterial hypertension subsets, risk assessment, survival




Corresponding Author: Yalın Tolga Yaylalı, Türkiye


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