Right Ventricular Index for Risk Stratification of Patients with Pulmonary Arterial Hypertension

Respiration. 2018;96(3):249-258. doi: 10.1159/000489231. Epub 2018 Jul 12.

Abstract

Background: Right ventricular (RV) dysfunction is a major prognostic predictor in pulmonary arterial hypertension (PAH).

Objectives: The objective of this study was to assess the prognostic impact of a newly developed index merging haemodynamic parameters into 1 variable.

Methods: We retrospectively assessed 2 cohorts of 248 patients (164 from Hamburg and 84 from Heidelberg) with invasively diagnosed PAH. During a median follow-up time of 3.6 years (3.1 and 4.0 years for Hamburg and Heidelberg, respectively), the composite endpoint of all-cause mortality and lung transplantation occurred in 57 patients (53 and 4 patients for Hamburg and Heidelberg, respectively). The RV index was developed in the Hamburg cohort and validated in the Heidelberg cohort: (right atrial pressure × pulmonary vascular resistance)/mixed venous oxygen saturation.

Results: Patients with a high RV index had a higher incidence of the combined endpoint in Kaplan-Meier analyses in the Hamburg and Heidelberg cohort (p = 0.017 and p = 0.034, respectively). The calculated RV index cut-off value was 91 and identified patients with a worse outcome in the Hamburg cohort and showed a trend in the Heidelberg cohort (p < 0.001 and p = 0.089, respectively). The RV index in Cox regression hazard models was an independent predictor of outcomes after adjustment for sex and age in both cohorts (Hamburg: hazard ratio [HR] 1.26 [95% CI 1.08, 1.47], p = 0.0027; Heidelberg: HR 2.27 [95% CI 1.46, 3.51], p < 0.001). A nomogram based on these results allowed risk stratification.

Conclusion: Merging 3 haemodynamic variables into 1 variable, the RV index increased the prognostic power up to an independent risk factor. The RV index is easy to calculate and allows the construction of a nomogram for an individualized risk assessment.

Keywords: Haemodynamic parameters; Index; Prognosis; Pulmonary arterial hypertension; Right heart catheterization; Risk stratification.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Aged
  • Female
  • Germany / epidemiology
  • Humans
  • Hypertension, Pulmonary / diagnosis
  • Hypertension, Pulmonary / mortality
  • Hypertension, Pulmonary / physiopathology*
  • Male
  • Middle Aged
  • Nomograms
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index*
  • Ventricular Function, Right*