Value of right heart haemodynamics for risk stratification of patients with pulmonary arterial hypertension at follow-up
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: ESC/ERS guidelines recommend risk stratification of prevalent patients with pulmonary arterial hypertension (PAH) using noninvasive parameters, whereas right heart haemodynamic parameters are left to the clinician's discretion if deemed necessary. The study aimed to define the possible contribution of invasive haemodynamic parameters in predicting both the risk of death from all causes and the risk of clinical worsening (CW) in patients with PAH categorized at follow-up by the noninvasive ESC/ERS 4-strata risk stratification model. METHODS: We evaluated incident patients with PAH enrolled in 11 Italian centres between 2005 and 2021 who had a first follow-up right heart catheterization within 6-12 months of diagnosis. In each noninvasive risk category, patients were subsequently stratified in a subgroup with a good haemodynamic profile if stroke volume index was ⩾38 mL/m2 and right atrial pressure was <8 mmHg and a subgroup with a poor haemodynamic profile if stroke volume index <38 ml/m2 and/or right atrial pressure ⩾8 mmHg. Median follow-up was 3.7 years (interquartile range 1.2-6.8) months. RESULTS: Among low-risk patients (n = 162) survival was similar, but the CW rate was better in the good haemodynamic compared with the poor haemodynamic subgroup (P = .033). Among patients at intermediate-low risk (n = 240), both survival and CW rates were significantly better in the good haemodynamic subgroup compared with the poor haemodynamic subgroup (P = .028 and P = .011, respectively). Among patients at intermediate-high risk (n = 339), the CW rate was similar but survival was significantly better in the good haemodynamic than in the poor haemodynamic subgroup (P = .015). In the high-risk group, only 1 out of 28 patients had a good haemodynamic profile. CONCLUSION: In prevalent patients with PAH, a good haemodynamic profile predicts better survival in intermediate-risk patients and, importantly, a lower CW rate in low-risk patients.
Source: ESC Heart Failure
Authors: Laura Scelsi, Roberto Badagliacca, Michele D’Alto, Mauro Acquaro, Pietro Ameri, Paola Argiento, Natale Daniele Brunetti, Gavino Casu, Nadia Cedrone, Paola Confalonieri, Marco Corda, Michele Correale, Carlo D’Agostino, Elisabetta De Tommasi, Domenico Filomena, Giuseppe Galgano, Alessandra Greco, Massimo Grimaldi, Carlo Lombardi, Rosalinda Madonna, Giovanna Manzi, Valentina Mercurio, Alexandra Mihai, Massimiliano Mulè, Giuseppe Paciocco, Silvia Papa, Tommaso Recchioni, Antonella Romaniello, Emanuele Romeo, Davide Stolfo, Annalisa Turco, Marco Vatrano, Patrizio Vitulo, Carmine Dario Vizza, Stefano Ghio, The Italian Pulmonary Hypertension NETwork (iPHNET), Piergiuseppe Agostoni, Carlo Albera, Davide Barbisan, Vincenzo Bellomo, Marta Beretta, Marco Biolo, Federico Biondi, Andrea Bonelli, Renato Carignola, Francesco Cassadonte, Maria Alberta Cattabiani, Vincenzo Antonio Ciconte, Marco Confalonieri, Chiara Cresci, Alessandra Cuomo, Raffaele De Caterina, Gabriele Di Gesaro, Stefania Farina, Martino Fortunato, Giulia Gagno, Pietro Geri, Daniele Ghiraldin, Daniela Giannazzo, Giorgio Giardina, Maria Chiara Grimaldi, Ludovico Lanfranchi, Mariangela Lattanzio, Antonella Mannarini, Lavinia Martino, Beatrice Pezzuto, Francesca Rampini, Imma Romanazzi, Susanna Sciomer, Gianmarco Scoccia, Piermario Scuri, Corrado Tamburino, Lucia Tricarico, Sara Uras
Institutions: Policlinico San Matteo Fondazione, Sapienza University of Rome, Ospedale Monaldi, Ospedale Policlinico San Martino, University of Genoa, University of Foggia, Azienda Ospedaliero Universitaria di Sassari, Ospedale Sandro Pertini, Ospedale di Cattinara, Azienda Ospedaliera G. Brotzu, Ospedali Riuniti di Foggia, Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari, Ospedale Generale Regionale Francesco Miulli, University of Brescia, University of Pisa, University of Naples Federico II, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Azienda Ospedaliera San Gerardo, Azienda Ospedaliera Sant'Andrea, Azienda sanitaria universitaria Giuliano Isontina, Azienda Ospedaliera Pugliese Ciaccio
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,850
OpenAlex ID: W7129531342