Chest
Original ResearchPulmonary Vascular DiseaseIntegration of Clinical and Hemodynamic Parameters in the Prediction of Long-term Survival in Patients With Pulmonary Arterial Hypertension
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Study Population and PAH Definition
All patients agreed to the use of their data for research purposes, and the study was approved by the Mayo Clinic institutional review board (Committee Expedited Review B-IRB No. 06-005447). The study included all adult patients (≥ 18 years) who fulfilled the contemporary diagnostic criteria for WHO group 1 pulmonary hypertension (PH) (mean pulmonary arterial pressure ≥ 25 mm Hg occurring in the setting of increases in precapillary pulmonary resistance) and were first seen (January 1, 1995, to
Clinical Characteristics
Clinical, laboratory, and hemodynamic characteristics at the time of diagnosis of the 484 individual subjects with WHO group 1 PH are shown in Table 1. A total of 272 subjects (56%) had idiopathic, familial, or anorexigenic PAH, 114 (24%) had PAH in the setting of connective tissue disease, and the remainder were associated with congenital systemic to pulmonary shunts (n = 45), portal hypertension (n = 51), and HIV (n = 2).
The majority of patients (75%) were women. The mean age was 52 ± 15
Discussion
The present study expands the available information of survival patterns in a large cohort of patients with PAH and provides new information on which clinical variables provide incremental prediction of survival. The emphasis of this article is on examining the usefulness of integrating the intrinsic characteristics (demographics and measurable clinical parameters) into the estimation of future risk of death in PAH. Our findings indicate that clinical parameters have the highest impact on
Conclusions
Our findings suggest that routine PAH clinical parameters can significantly enhance prediction of survival over functional class alone. Patients with PAH who are functional class II-III but have a REVEAL risk score > 8 have a risk equivalent to those patients presenting in functional class IV. We propose that these patients be considered for aggressive treatment protocols such as first-line parenteral prostacyclin analog therapy and suggest that this approach be tested in future studies.
Acknowledgments
Author contributions: Dr Kane had access to the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Kane: contributed to study concept and design, analysis and interpretation of the data, and drafting of the manuscript.
Dr Maradit-Kremers: contributed to study concept and design, analysis and interpretation of the data, statistical expertise, and critical revision of the manuscript.
Mr Slusser: contributed to study concept and design, analysis and
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2019, Mayo Clinic ProceedingsCitation Excerpt :The right atrial (RA) pressure was estimated using assessment of the size of the inferior vena cava (IVC) at baseline and during deep inspiration. Right atrial pressure was estimated at 5 mm Hg when the IVC diameter was less than 2.1 cm, 10 mm Hg if the diameter was 2.1 cm or greater or if the IVC failed to collapse by more than 50% during inspiration, 15 mm Hg if the IVC diameter was 2.1 cm or greater and the IVC failed to collapse by more than 50% during inspiration, and 20 mm Hg if the IVC was 2.1 cm or greater and respiratory variation was absent.11 Descriptive statistics are presented as frequencies with percentages for categorical variables, and continuous data are reported as means with standard deviation or medians with interquartile range (IQR) as appropriate for the data distribution.
Funding/Support: This project was supported by an unrestricted research grant from Pfizer Inc.
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