Mortality in pulmonary arterial hypertension: Prediction by the 2015 European pulmonary hypertension guidelines risk stratification model

Marius M. Hoeper, Tilmann Kramer, Zixuan Pan, Christina A. Eichstaedt, Jens Spiesshoefer, Nicola Benjamin, Karen M. Olsson, Katrin Meyer, Carmine Dario Vizza, Anton Vonk-Noordegraaf, Oliver Distler, Christian Opitz, J. Simon R. Gibbs, Marion Delcroix, H. Ardeschir Ghofrani, Doerte Huscher, David Pittrow, Stephan Rosenkranz, Ekkehard Grünig

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

The 2015 European pulmonary hypertension (PH) guidelines propose a risk stratification strategy for patients with pulmonary arterial hypertension (PAH). Low-, intermediate- and high-risk strata are defined by estimated 1-year mortality risks of <5%, 5-10% and >10%, respectively. This risk assessment strategy awaits validation. We analysed data from patients with newly diagnosed PAH enrolled into COMPERA (Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension), a European-based PH registry. An abbreviated version of the risk assessment strategy proposed by the European PH guidelines was applied, using the following variables: World Health Organization functional class, 6-min walking distance, brain natriuretic peptide or its N-terminal fragment, right atrial pressure, cardiac index and mixed venous oxygen saturation. Data from 1588 patients were analysed. Mortality rates were significantly different between the three risk strata (p<0.001 for all comparisons). In the entire patient population, the observed mortality rates 1 year after diagnosis were 2.8% in the low-risk cohort (n=196), 9.9% in the intermediate-risk cohort (n=1116) and 21.2% in the high-risk cohort (n=276). In addition, the risk assessment strategy proved valid at follow-up and in major PAH subgroups. An abbreviated version of the risk assessment strategy proposed by the current European PH guidelines provides accurate mortality estimates in patients with PAH.

Original languageEnglish
Article number1700740
JournalEuropean Respiratory Journal
Volume50
Issue number2
DOIs
Publication statusPublished - 1 Aug 2017

Cite this

Hoeper, Marius M. ; Kramer, Tilmann ; Pan, Zixuan ; Eichstaedt, Christina A. ; Spiesshoefer, Jens ; Benjamin, Nicola ; Olsson, Karen M. ; Meyer, Katrin ; Vizza, Carmine Dario ; Vonk-Noordegraaf, Anton ; Distler, Oliver ; Opitz, Christian ; Gibbs, J. Simon R. ; Delcroix, Marion ; Ghofrani, H. Ardeschir ; Huscher, Doerte ; Pittrow, David ; Rosenkranz, Stephan ; Grünig, Ekkehard. / Mortality in pulmonary arterial hypertension : Prediction by the 2015 European pulmonary hypertension guidelines risk stratification model. In: European Respiratory Journal. 2017 ; Vol. 50, No. 2.
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title = "Mortality in pulmonary arterial hypertension: Prediction by the 2015 European pulmonary hypertension guidelines risk stratification model",
abstract = "The 2015 European pulmonary hypertension (PH) guidelines propose a risk stratification strategy for patients with pulmonary arterial hypertension (PAH). Low-, intermediate- and high-risk strata are defined by estimated 1-year mortality risks of <5{\%}, 5-10{\%} and >10{\%}, respectively. This risk assessment strategy awaits validation. We analysed data from patients with newly diagnosed PAH enrolled into COMPERA (Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension), a European-based PH registry. An abbreviated version of the risk assessment strategy proposed by the European PH guidelines was applied, using the following variables: World Health Organization functional class, 6-min walking distance, brain natriuretic peptide or its N-terminal fragment, right atrial pressure, cardiac index and mixed venous oxygen saturation. Data from 1588 patients were analysed. Mortality rates were significantly different between the three risk strata (p<0.001 for all comparisons). In the entire patient population, the observed mortality rates 1 year after diagnosis were 2.8{\%} in the low-risk cohort (n=196), 9.9{\%} in the intermediate-risk cohort (n=1116) and 21.2{\%} in the high-risk cohort (n=276). In addition, the risk assessment strategy proved valid at follow-up and in major PAH subgroups. An abbreviated version of the risk assessment strategy proposed by the current European PH guidelines provides accurate mortality estimates in patients with PAH.",
author = "Hoeper, {Marius M.} and Tilmann Kramer and Zixuan Pan and Eichstaedt, {Christina A.} and Jens Spiesshoefer and Nicola Benjamin and Olsson, {Karen M.} and Katrin Meyer and Vizza, {Carmine Dario} and Anton Vonk-Noordegraaf and Oliver Distler and Christian Opitz and Gibbs, {J. Simon R.} and Marion Delcroix and Ghofrani, {H. Ardeschir} and Doerte Huscher and David Pittrow and Stephan Rosenkranz and Ekkehard Gr{\"u}nig",
year = "2017",
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doi = "10.1183/13993003.00740-2017",
language = "English",
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Hoeper, MM, Kramer, T, Pan, Z, Eichstaedt, CA, Spiesshoefer, J, Benjamin, N, Olsson, KM, Meyer, K, Vizza, CD, Vonk-Noordegraaf, A, Distler, O, Opitz, C, Gibbs, JSR, Delcroix, M, Ghofrani, HA, Huscher, D, Pittrow, D, Rosenkranz, S & Grünig, E 2017, 'Mortality in pulmonary arterial hypertension: Prediction by the 2015 European pulmonary hypertension guidelines risk stratification model' European Respiratory Journal, vol. 50, no. 2, 1700740. https://doi.org/10.1183/13993003.00740-2017

Mortality in pulmonary arterial hypertension : Prediction by the 2015 European pulmonary hypertension guidelines risk stratification model. / Hoeper, Marius M.; Kramer, Tilmann; Pan, Zixuan; Eichstaedt, Christina A.; Spiesshoefer, Jens; Benjamin, Nicola; Olsson, Karen M.; Meyer, Katrin; Vizza, Carmine Dario; Vonk-Noordegraaf, Anton; Distler, Oliver; Opitz, Christian; Gibbs, J. Simon R.; Delcroix, Marion; Ghofrani, H. Ardeschir; Huscher, Doerte; Pittrow, David; Rosenkranz, Stephan; Grünig, Ekkehard.

In: European Respiratory Journal, Vol. 50, No. 2, 1700740, 01.08.2017.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Mortality in pulmonary arterial hypertension

T2 - Prediction by the 2015 European pulmonary hypertension guidelines risk stratification model

AU - Hoeper, Marius M.

AU - Kramer, Tilmann

AU - Pan, Zixuan

AU - Eichstaedt, Christina A.

AU - Spiesshoefer, Jens

AU - Benjamin, Nicola

AU - Olsson, Karen M.

AU - Meyer, Katrin

AU - Vizza, Carmine Dario

AU - Vonk-Noordegraaf, Anton

AU - Distler, Oliver

AU - Opitz, Christian

AU - Gibbs, J. Simon R.

AU - Delcroix, Marion

AU - Ghofrani, H. Ardeschir

AU - Huscher, Doerte

AU - Pittrow, David

AU - Rosenkranz, Stephan

AU - Grünig, Ekkehard

PY - 2017/8/1

Y1 - 2017/8/1

N2 - The 2015 European pulmonary hypertension (PH) guidelines propose a risk stratification strategy for patients with pulmonary arterial hypertension (PAH). Low-, intermediate- and high-risk strata are defined by estimated 1-year mortality risks of <5%, 5-10% and >10%, respectively. This risk assessment strategy awaits validation. We analysed data from patients with newly diagnosed PAH enrolled into COMPERA (Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension), a European-based PH registry. An abbreviated version of the risk assessment strategy proposed by the European PH guidelines was applied, using the following variables: World Health Organization functional class, 6-min walking distance, brain natriuretic peptide or its N-terminal fragment, right atrial pressure, cardiac index and mixed venous oxygen saturation. Data from 1588 patients were analysed. Mortality rates were significantly different between the three risk strata (p<0.001 for all comparisons). In the entire patient population, the observed mortality rates 1 year after diagnosis were 2.8% in the low-risk cohort (n=196), 9.9% in the intermediate-risk cohort (n=1116) and 21.2% in the high-risk cohort (n=276). In addition, the risk assessment strategy proved valid at follow-up and in major PAH subgroups. An abbreviated version of the risk assessment strategy proposed by the current European PH guidelines provides accurate mortality estimates in patients with PAH.

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DO - 10.1183/13993003.00740-2017

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