Objective To optimise treatment of patients with pulmonary arterial hypertension (PAH), the 2015 European Society of Cardiology/European Respiratory Society guidelines recommend using risk stratification, with the aim of patients achieving low-risk status. Previous analyses of registries made progress in using risk stratification approaches, however, the focus is often on patients with a low-risk prognosis, whereas most PAH patients are in intermediate-risk or high-risk categories. Using only six parameters with high prognostic relevance, we aimed to demonstrate a pragmatic approach to individual patient risk assessment to discriminate between patients at low risk, intermediate risk and high risk of death. Methods Risk assessment was performed combining six parameters in four criteria: (1) WHO functional class, (2) 6 min walk distance, (3) N-terminal pro-brain natriuretic peptide (BNP)/BNP plasma levels or right atrial pressure and (4) cardiac index or mixed venous oxygen saturation. Assessments were made at baseline and at first follow-up after 3–4 months. Results 725 PAH treatment-naive patients were analysed. Survival estimates between risk groups were statistically significant at baseline and first follow-up (p<0.001), even when the analysis was performed within PAH etiological subgroups. Similar results were observed in 208 previously treated PAH patients. Furthermore, patients who remained at or improved to low risk had a significantly better estimated survival compared with patients who remained at or worsened to intermediate risk or high risk (p≤0.005). Conclusion The simplified risk-assessment method can discriminate idiopathic, connective-tissue-disease-associated and congenital-heart-disease-associated PAH patients into meaningful high-risk, intermediate-risk and low-risk groups at baseline and first follow-up. This pragmatic approach reinforces targeting a low-risk profile for PAH patients. Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplemental information. All provided data included in the article cannot be traced back to individuals that participated in the study.

中文翻译：

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使用 2015 年欧洲心脏病学会/欧洲呼吸学会指南进行肺动脉高压风险评估的务实方法


目的 为了优化肺动脉高压（PAH）患者的治疗，2015 年欧洲心脏病学会/欧洲呼吸学会指南建议采用风险分层，旨在使患者达到低风险状态。先前的登记分析在使用风险分层方法方面取得了进展，然而，重点往往是低风险预后的患者，而大多数 PAH 患者属于中风险或高风险类别。我们仅使用六个具有高度预后相关性的参数，旨在展示一种实用的个体患者风险评估方法，以区分低风险、中风险和高死亡风险的患者。方法 结合四个标准中的六个参数进行风险评估：(1) WHO 功能分级，(2) 6 分钟步行距离，(3) N 端脑钠肽前体 (BNP)/BNP 血浆水平或右心房压力，以及(4)心脏指数或混合静脉血氧饱和度。在基线和 3-4 个月后的首次随访时进行评估。结果 对 725 名未接受过治疗的 PAH 患者进行了分析。即使在 PAH 病因亚组内进行分析，风险组之间的生存估计在基线和首次随访时也具有统计学显着性 (p<0.001)。在 208 名既往接受过治疗的 PAH 患者中也观察到了类似的结果。此外，与保持或恶化至中度风险或高风险的患者相比，保持或改善至低风险的患者的估计生存率明显更高（p≤0.005）。 结论 简化的风险评估方法可以在基线和首次随访时将特发性、结缔组织病相关性和先天性心脏病相关性PAH患者区分为有意义的高风险、中风险和低风险组。这种务实的方法强化了针对 PAH 患者的低风险状况。可根据合理要求提供数据。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。文章中提供的所有数据都无法追溯到参与该研究的个人。