Background: Risk assessment in pulmonary arterial hypertension (PAH) is essential for prognostication. However, the majority of patients end-up in an intermediate risk status, offering insufficient guidance in clinical practice. The added value of cardiopulmonary exercise testing in this setting remains undefined. Methods: Two independent cohorts with idiopathic PAH at intermediate risk were used to develop (n = 124) and externally validate (n = 143) the prognostic model. Cross-validation on the overall population was used to strengthen the results of the analysis. Risk assessment was based on the simplified version of the ESC/ERS guidelines score. Discrimination and calibration were assessed. Results: A risk score was constructed based on the beta-coefficient of the cross-validated model, including the stroke volume index (SVI) and the peak oxygen uptake (VO2 peak). Patients were grouped based on cutoff values of the risk score allowing the highest discrimination in the overall cohort. Group 1, score ≤2 (101 patients) with VO2 peak ≥14 ml/kg/min and SVI >30 ml/m2; Group 2, score between 2 and 5 (112 patients) with VO2 peak between 9 and 14 ml/kg/min, and SVI between 20 and 50 ml/m2; Group 3, score >5 (46 patients) with VO2 peak <10 ml/kg/min and SVI <30 ml/m2. The event-free survival rates at 1, 2 and 3 years, were 96%, 83% and 79% for Group 1, respectively; 82%, 67% and 52% for Group 2; 69%, 50% and 41% for Group 3. Conclusions: Combinations of VO2 peak and SVI may provide important information to further stratify intermediate-risk prevalent patients with idiopathic PAH.

Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension / Badagliacca, R.; Rischard, F.; Giudice, F. L.; Howard, L.; Papa, S.; Valli, G.; Manzi, G.; Sciomer, S.; Palange, P.; Garcia, J. G. N.; Vanderpool, R.; Rinaldo, R.; Vigo, B.; Insel, M.; Fedele, F.; Vizza, C. D.. - In: THE JOURNAL OF HEART AND LUNG TRANSPLANTATION. - ISSN 1053-2498. - 41:6(2022), pp. 780-790. [10.1016/j.healun.2022.02.021]

Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension

Badagliacca R.
;
Papa S.;Manzi G.;Sciomer S.;Palange P.;Fedele F.;Vizza C. D.
2022

Abstract

Background: Risk assessment in pulmonary arterial hypertension (PAH) is essential for prognostication. However, the majority of patients end-up in an intermediate risk status, offering insufficient guidance in clinical practice. The added value of cardiopulmonary exercise testing in this setting remains undefined. Methods: Two independent cohorts with idiopathic PAH at intermediate risk were used to develop (n = 124) and externally validate (n = 143) the prognostic model. Cross-validation on the overall population was used to strengthen the results of the analysis. Risk assessment was based on the simplified version of the ESC/ERS guidelines score. Discrimination and calibration were assessed. Results: A risk score was constructed based on the beta-coefficient of the cross-validated model, including the stroke volume index (SVI) and the peak oxygen uptake (VO2 peak). Patients were grouped based on cutoff values of the risk score allowing the highest discrimination in the overall cohort. Group 1, score ≤2 (101 patients) with VO2 peak ≥14 ml/kg/min and SVI >30 ml/m2; Group 2, score between 2 and 5 (112 patients) with VO2 peak between 9 and 14 ml/kg/min, and SVI between 20 and 50 ml/m2; Group 3, score >5 (46 patients) with VO2 peak <10 ml/kg/min and SVI <30 ml/m2. The event-free survival rates at 1, 2 and 3 years, were 96%, 83% and 79% for Group 1, respectively; 82%, 67% and 52% for Group 2; 69%, 50% and 41% for Group 3. Conclusions: Combinations of VO2 peak and SVI may provide important information to further stratify intermediate-risk prevalent patients with idiopathic PAH.
2022
cardiopulmonary exercise test; clinical worsening; oxygen uptake; pulmonary arterial hypertension; validation
01 Pubblicazione su rivista::01a Articolo in rivista
Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension / Badagliacca, R.; Rischard, F.; Giudice, F. L.; Howard, L.; Papa, S.; Valli, G.; Manzi, G.; Sciomer, S.; Palange, P.; Garcia, J. G. N.; Vanderpool, R.; Rinaldo, R.; Vigo, B.; Insel, M.; Fedele, F.; Vizza, C. D.. - In: THE JOURNAL OF HEART AND LUNG TRANSPLANTATION. - ISSN 1053-2498. - 41:6(2022), pp. 780-790. [10.1016/j.healun.2022.02.021]
File allegati a questo prodotto
File Dimensione Formato  
Badagliacca_Incremental_2022.pdf

solo gestori archivio

Note: lavoro in esteso
Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 849.92 kB
Formato Adobe PDF
849.92 kB Adobe PDF   Contatta l'autore

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1635320
Citazioni
  • ???jsp.display-item.citation.pmc??? 5
  • Scopus 14
  • ???jsp.display-item.citation.isi??? 12
social impact