A simple hemodynamic parameter to predict clinical worsening in pulmonary arterial hypertension

Predicting prognosis is a cornerstone in management of pulmonary arterial hypertension. Hemodynamic parameters are among the robust indicators of right ventricular function and prognosis. In this study we have investigated the association of a simple hemodynamic parameter with clinical worsening in pulmonary arterial hypertension.

120 patients were enrolled in a single center prospective cohort study after confirmation of precapillary pulmonary hypertension and were followed for an average of 36months on guideline recommended treatment protocols. cSvO₂ was calculated as the ratio of right atrial pressure over Mixed Venous Oxygen Saturation. Independent predictors of clinical worsening were identified using multivariable Cox regression models.

By the end of the follow up a total of 21 patients died and 63 were hospitalized for pulmonary hypertension. Time-to-event Cox regression model showed a strong association between cSvO₂ and time to clinical worsening (HR: 250.13, CI: (38.56-1622.34) &p-value: <0.0001).

The index of cSvO₂ includes both parameters of cardiac output and right ventricular filling pressure and might be beneficial in predicting clinical worsening in patients with pulmonary arterial hypertension.