Risk assessment in precapillary pulmonary hypertension: a comparative analysis

Area of Science:

• Cardiology
• Pulmonary Medicine
• Medical Statistics

Background:

• Risk stratification is vital for managing precapillary pulmonary hypertension (PH).
• Accurate mortality risk assessment guides treatment decisions in PH patients.
• Current risk stratification tools require evaluation for improved accuracy.

Purpose of the Study:

• To compare the accuracy of different PH risk stratification tools.
• To evaluate the significance of specific risk parameters in PH mortality prediction.
• To identify areas for improvement in risk assessment for PH patients.

Main Methods:

• Retrospective longitudinal observational cohort study.
• Evaluation of seven risk assessment approaches based on current PH guidelines.
• Multi-parametric risk stratification at baseline and follow-up, analyzed with Cox hazard models.

Main Results:

• Existing risk models accurately predicted mortality in precapillary PH.
• Right-heart catheterization parameters were not essential for risk prediction.
• Non-invasive follow-up assessments significantly enhanced risk estimation accuracy, especially in intermediate- and high-risk groups.

Conclusions:

• Current abbreviated risk tools (ESC/ERS, REVEAL 2.0/Lite 2) lack precision for intermediate-to-high risk PH.
• An expanded non-invasive evaluation, including age and right atrium area, significantly improves mortality risk prediction.
• Refined risk stratification is needed for better PH patient management.