Integration of clinical and hemodynamic parameters in the prediction of long-term survival in patients with pulmonary arterial hypertension

Garvan M Kane, Hilal D Maradit Kremers, Josh P. Slusser, Chris G. Scott, Robert Frantz, Michael D. McGoon

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

Background: Current management guidelines for pulmonary arterial hypertension (PAH) recommend a treatment choice based primarily on World Health Organization (WHO) functional class. This study was designed to assess how the incorporation of readily obtained clinical and test-based information may significantly improve the prediction of outcomes over functional class alone. Methods: Clinical and hemodynamic variables were assessed in 484 consecutive patients presenting with WHO group 1 PAH. The primary outcome measure was time to all-cause mortality over 5 years from the index presentation (data available in all). Follow-up was censored at the time of lung or heart/lung transplant in 21 patients or at 5 years. Predictors of mortality were assessed sequentially using Cox models, with the step-wise incorporation of clinical variables, echocardiographic, and catheterization findings. Results were further compared with the REVEAL (Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management) prediction score. Results: Overall median survival was 237 weeks (95% CI, 196-266), corresponding to 1-year, 3-year, and 5-year survival rates of 81.1% (77.0, 84.7), 61.1% (56.5, 65.3), and 47.9% (43.2, 52.4), respectively. The prediction of mortality was improved incrementally by incorporating clinical and echocardiographic measures with a concordance index (c-index) of 0.84 compared with that of 0.60 with functional class alone. The REVEAL prediction score was validated independently in this cohort to predict both 1-year and 5-year mortality. It had a prediction c-index of 0.71. Conclusions: The integration of routine PAH clinical (predominantly noninvasive) parameters predicts long-term outcome better than functional class and, hence, should be incorporated into medical management decisions.

Original languageEnglish (US)
Pages (from-to)1285-1293
Number of pages9
JournalChest
Volume139
Issue number6
DOIs
StatePublished - Jun 1 2011

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Pulmonary Hypertension
Hemodynamics
Survival
Mortality
Lung
Disease Management
Proportional Hazards Models
Catheterization
Registries
Survival Rate
Outcome Assessment (Health Care)
Guidelines
Transplants
Therapeutics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Integration of clinical and hemodynamic parameters in the prediction of long-term survival in patients with pulmonary arterial hypertension. / Kane, Garvan M; Maradit Kremers, Hilal D; Slusser, Josh P.; Scott, Chris G.; Frantz, Robert; McGoon, Michael D.

In: Chest, Vol. 139, No. 6, 01.06.2011, p. 1285-1293.

Research output: Contribution to journalArticle

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