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Reevaluating risk assessment in connective tissue disease-associated pulmonary arterial hypertension: The prognostic
Qingqing Cai1,2, Huangshu Ye2, Yixin Zhang3
1Department of Gerontology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China.
Insights
Stroke volume index (SVI) offers superior risk stratification for connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) compared to cardiac index (CI). SVI better predicts patient outcomes and survival, aiding in clinical decision-making.
Area of Science:
- Cardiology
- Pulmonary Hypertension
- Rheumatology
Background:
- Connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) poses significant prognostic challenges.
- Accurate risk stratification is crucial for managing CTD-PAH patients and predicting outcomes.
- Current risk assessment tools may have limitations in comprehensively evaluating CTD-PAH prognosis.
Purpose of the Study:
- To evaluate the prognostic value of stroke volume index (SVI) versus cardiac index (CI) in risk stratification for CTD-PAH.
- To determine if SVI offers superior outcome prediction compared to CI in this patient population.
- To identify optimal SVI cut-off values for risk categorization in CTD-PAH.
Main Methods:
- Retrospective analysis of 206 CTD-PAH patients from two Chinese medical centers.
- Risk stratification using the 2018 World Symposia on Pulmonary Hypertension (WSPH) framework.
- Kaplan-Meier curves, restricted cubic splines, and ROC analysis to assess SVI and CI predictive accuracy.
Main Results:
- Stroke volume index (SVI) demonstrated superior risk stratification compared to cardiac index (CI) in CTD-PAH.
- SVI-based stratification identified significant differences in survival and event-free survival rates.
- 55 out of 206 patients showed discrepancies in risk stratification between SVI and CI.
Conclusions:
- Stroke volume index (SVI) enhances risk stratification and prognosis prediction in CTD-PAH.
- SVI effectively distinguishes patients at higher risk for adverse outcomes.
- SVI provides a more accurate prognostic assessment than CI in CTD-PAH.
Objective:
To evaluate the prognostic value of stroke volume index (SVI) compared to cardiac index (CI) in risk stratification and outcome prediction in connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH).
Methods:
We performed a retrospective analysis of patients diagnosed with CTD-PAH through right heart catheterization (RHC) from two Chinese medical centers. This retrospective study analyzed 206 CTD-PAH patients, with risk stratification performed using the 2018 World Symposia on Pulmonary Hypertension (WSPH) framework. Restricted cubic splines (RCS) and log-rank tests were utilized to identify the optimal SVI cutof values for categorizing patients into low-, intermediate-, and high-risk groups. Kaplan-Meier (KM) curves were used to analyze survival rates and event-free survival. Receiver operating characteristic (ROC) analysis was used to assess the predictive accuracy of diferent models for prognostic outcomes.
Results:
SVI was categorized into low-risk (SVI ≥ 33.35 mL/m2), intermediate-risk (24.66 mL/m2≤ SVI < 33.35 mL/m2), and high-risk (SVI < 24.66 mL/m2) groups. Among the 206 CTD-PAH patients, 55 exhibited discrepancies in risk stratification between CI and SVI. SVI-based stratification provided more accurate risk categorization and demonstrated superior predictive value compared to CI, showing significant diferences in both survival and event-free survival rates across the groups.
Conclusion:
SVI enhances risk stratification and prognosis prediction in CTD-PAH by efectively distinguishing patients at higher risk for adverse outcomes.
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