Outcomes in Pulmonary Arterial Hypertension: Results from a Single Center in Romania

Background/Objectives: Real-world data on pulmonary arterial hypertension (PAH) in Romania are scarce. This study evaluated the clinical characteristics, long-term survival patterns and the prognostic utility of baseline variables in a Romanian PAH cohort. Methods: We retrospectively analyzed adult patients treated for PAH at a single expert center between 2007 and 2026. The primary outcome was a composite of all-cause mortality or lung transplantation. Survival was assessed using Kaplan-Meier and univariable Cox proportional-hazard regression models. Univariable and multivariable linear regressions were used to identify drivers of baseline estimated glomerular filtration rate (eGFR). Results: The primary analysis cohort included 75 patients (mean age 53 ± 15 years, 71% female). Overall transplant-free survival was unexpectedly high at 97.2%, 80.8%, and 66.7% at 1, 3, and 5 years, respectively. The European Society of Cardiology (ESC)/European Respiratory Society (ERS) 3-strata risk score did not stratify survival (log-rank p = 0.9). Significant predictors of adverse outcomes in univariable analysis included six-minute walking distance (6MWD), PAH etiology and baseline coronary artery disease. In univariable analysis, lower baseline eGFR was associated with age, hypertension and diabetes mellitus, but not with pulmonary hemodynamics or transplant-free survival. Conclusions: In this regional PAH cohort, survival rates were high, likely reflecting survivor bias stemming from delayed access to care. Adverse outcomes were associated with PAH etiology and 6MWD, but the limited number of events precluded multivariable analysis.