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Risk stratification in chronic thromboembolic pulmonary hypertension predicts survival

Sandqvist, Anna ; Kylhammar, David LU ; Bartfay, Sven Erik ; Hesselstrand, Roger LU ; Hjalmarsson, Clara ; Kavianipour, Mohammad ; Nisell, Magnus ; Rådegran, Göran LU ; Wikström, Gerhard and Kjellström, Barbro LU , et al. (2020) In Scandinavian Cardiovascular Journal
Abstract

Objectives. To investigate if the pulmonary arterial hypertension (PAH) risk assessment tool presented in the 2015 ESC/ERS guidelines is valid for patients with chronic thromboembolic pulmonary hypertension (CTEPH) when taking pulmonary endarterectomy (PEA) into account. Design. Incident CTEPH patients registered in the Swedish PAH Registry (SPAHR) between 2008 and 2016 were included. Risk stratification performed at baseline and follow-up classified the patients as low-, intermediate-, or high-risk using the proposed ESC/ERS risk algorithm. Results. There were 250 CTEPH patients with median age (interquartile range) 70 (14) years, and 53% were male. Thirty-two percent underwent PEA within 5 (6) months. In a multivariable model... (More)

Objectives. To investigate if the pulmonary arterial hypertension (PAH) risk assessment tool presented in the 2015 ESC/ERS guidelines is valid for patients with chronic thromboembolic pulmonary hypertension (CTEPH) when taking pulmonary endarterectomy (PEA) into account. Design. Incident CTEPH patients registered in the Swedish PAH Registry (SPAHR) between 2008 and 2016 were included. Risk stratification performed at baseline and follow-up classified the patients as low-, intermediate-, or high-risk using the proposed ESC/ERS risk algorithm. Results. There were 250 CTEPH patients with median age (interquartile range) 70 (14) years, and 53% were male. Thirty-two percent underwent PEA within 5 (6) months. In a multivariable model adjusting for age, sex, and pharmacological treatment, patients with intermediate-risk or high-risk profiles at baseline displayed an increased mortality risk (Hazard Ratio [95% confidence interval]: 1.64 [0.69–3.90] and 5.39 [2.13–13.59], respectively) compared to those with a low-risk profile, whereas PEA was associated with better survival (0.38 [0.18–0.82]). Similar impact of risk profile and PEA was seen at follow-up. Conclusion. The ESC/ERS risk assessment tool identifies CTEPH patients with reduced survival. Furthermore, PEA improves survival markedly independently of risk group and age. Take home message: The ESC/ERS risk stratification for PAH predicts survival also in CTEPH patients, even when taking PEA into account.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
CTEPH, goal-oriented treatment, pulmonary endarterectomy, risk stratification, survival
in
Scandinavian Cardiovascular Journal
publisher
Taylor & Francis
external identifiers
  • scopus:85087175481
  • pmid:32586166
ISSN
1401-7431
DOI
10.1080/14017431.2020.1783456
language
English
LU publication?
yes
id
506ceeff-e7af-4532-afe5-eee77f639c38
date added to LUP
2020-07-17 14:30:23
date last changed
2021-03-24 05:34:23
@article{506ceeff-e7af-4532-afe5-eee77f639c38,
  abstract     = {<p>Objectives. To investigate if the pulmonary arterial hypertension (PAH) risk assessment tool presented in the 2015 ESC/ERS guidelines is valid for patients with chronic thromboembolic pulmonary hypertension (CTEPH) when taking pulmonary endarterectomy (PEA) into account. Design. Incident CTEPH patients registered in the Swedish PAH Registry (SPAHR) between 2008 and 2016 were included. Risk stratification performed at baseline and follow-up classified the patients as low-, intermediate-, or high-risk using the proposed ESC/ERS risk algorithm. Results. There were 250 CTEPH patients with median age (interquartile range) 70 (14) years, and 53% were male. Thirty-two percent underwent PEA within 5 (6) months. In a multivariable model adjusting for age, sex, and pharmacological treatment, patients with intermediate-risk or high-risk profiles at baseline displayed an increased mortality risk (Hazard Ratio [95% confidence interval]: 1.64 [0.69–3.90] and 5.39 [2.13–13.59], respectively) compared to those with a low-risk profile, whereas PEA was associated with better survival (0.38 [0.18–0.82]). Similar impact of risk profile and PEA was seen at follow-up. Conclusion. The ESC/ERS risk assessment tool identifies CTEPH patients with reduced survival. Furthermore, PEA improves survival markedly independently of risk group and age. Take home message: The ESC/ERS risk stratification for PAH predicts survival also in CTEPH patients, even when taking PEA into account.</p>},
  author       = {Sandqvist, Anna and Kylhammar, David and Bartfay, Sven Erik and Hesselstrand, Roger and Hjalmarsson, Clara and Kavianipour, Mohammad and Nisell, Magnus and Rådegran, Göran and Wikström, Gerhard and Kjellström, Barbro and Söderberg, Stefan},
  issn         = {1401-7431},
  language     = {eng},
  month        = {06},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Cardiovascular Journal},
  title        = {Risk stratification in chronic thromboembolic pulmonary hypertension predicts survival},
  url          = {http://dx.doi.org/10.1080/14017431.2020.1783456},
  doi          = {10.1080/14017431.2020.1783456},
  year         = {2020},
}