Right atrial pressure/pulmonary artery wedge pressure ratio: A more specific predictor of survival in pulmonary arterial hypertension
Right atrial pressure/pulmonary artery wedge pressure ratio: A more specific predictor of survival in pulmonary arterial hypertension
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DOI：
10.1016/j.healun.2015.12.028
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发表时间：
2016-06-01
影响因子：
8.9
通讯作者：
Dweik, Raed A.
中科院分区：
文献类型：
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作者：
Fares, Wassim H.;Bellumkonda, Lavanya;Dweik, Raed A.
背景：肺动脉高压（PAH）是一种进行性、致命的疾病。目前的预后模型并不理想，需要确定更准确的预后变量。本研究的目的是评估 PAH 患者右心房压/肺动脉楔压 (RAP/PAWP) 比值的相对预后价值。我们假设 RAP/PAWP 比率比任何其他测量或计算的血流动力学变量更能预测生存。 方法：我们对 PAH 队列（队列 1）进行了二次分析，并在单独的队列（队列 2）中验证了我们的结果。第 1 组主要包括参加前瞻性、短期、随机临床试验并随后进行长期随访的患者。第 2 组包括在三级 PAH 转诊中心前瞻性登记的患者。 结果：第 1 组 (n = 847) 和第 2 组 (n = 697) 的平均年龄分别为 47 岁和 54 岁。大多数患者为女性（分别为 78% 和 73%）、白人（83% 和 82%），患有晚期功能分级疾病状态（纽约心脏协会功能分级 Iota Iota Iota/IV 85% 和 68%），血流动力学显着升高（平均 RAP/PAWP 比值：1.2 和 1.0；肺血管阻力：13.5 和 9.4 Wood 单位）。 RAP/PAWP 比率表明 1 年风险比分别为 1.44 (p = 0.0001) 和 1.35 (p < 0.0001)，并且是 2 个队列中最一致的预测血流动力学变量。即使在多变量回归模型中针对其他协变量进行调整后，这些结果仍然有效。结论：RAP/PAWP 比值是比任何其他血流动力学变量更具体的生存预测因子，我们建议将其用于临床预后和 PAH 预测模型。 (C) 2016 年国际心肺移植学会。版权所有。
BACKGROUND: Pulmonary arterial hypertension (PAH) is a progressive, fatal disease. Current prognostic models are not ideal, and identifying more accurate prognostic variables is needed. The objective of this study was to evaluate the relative prognostic value of the right atrial pressure/pulmonary artery wedge pressure (RAP/PAWP) ratio in PAH patients. We hypothesized that the RAP/PAWP ratio is more predictive of survival than any of the other measured or calculated hemodynamic variables.METHODS: We performed a secondary analysis of a PAH cohort (Cohort 1) and validated our results in a separate cohort (Cohort 2). Cohort 1 included primarily patients enrolled in prospective, short-term, randomized clinical trials and subsequently followed long term. Cohort 2 included patients prospectively enrolled in a PAH registry at a tertiary PAH referral center.RESULTS: Cohort 1 (n = 847) and Cohort 2 (n = 697) had a mean age of 47 and 54 years, respectively. Most were female (78% and 73%, respectively), Caucasian (83% and 82%), with advanced functional class disease status (New York Heart Association Functional Class Iota Iota Iota/IV 85% and 68%) and with significantly elevated hemodynamics (mean RAP/PAWP ratio: 1.2 and 1.0; pulmonary vascular resistance: 13.5 and 9.4 Wood units). RAP/PAWP ratio indicated a 1-year hazard ratio of 1.44 (p = 0.0001) and 1.35, respectively (p < 0.0001), and was the most consistently predictive hemodynamic variable across the 2 cohorts. These results remain valid even when adjusted for other covariables in multivariable regression models.CONCLUSIONS: The RAP/PAWP ratio is a more specific predictor of survival than any other hemodynamic,variable, and we recommend that it be used in clinical prognostication and PAH predictive models. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.