RATIONALE The mean pulmonary arterial wedge pressure (mPAWP) is the critical hemodynamic factor differentiating Group 1 pulmonary arterial hypertension (PAH) from Group 2 pulmonary hypertension (PH) associated with left heart disease. Despite discrepancy between the mPAWP upper physiologic-normal and current PAH definition, the implications of the initial mPAWP for PAH clinical trajectory are poorly understood. OBJECTIVES To model longitudinal mPAWP trajectories in PAH over 10 years and examine the clinical and hemodynamic factors associated with trajectory membership. METHODS Adult PAH patients with ≥2 right heart catheterizations were identified from a multi-institution healthcare system in eastern Massachusetts. mPAWP trajectories were constructed via group-based trajectory modeling. Feature selection was performed in least absolute shrinkage and selection operator regression. Logistic regression was used to assess associations between trajectory membership, baseline characteristics, and transplant-free survival. MAIN RESULTS Among 301 PAH patients, there were two distinct mPAWP trajectories, termed mPAWP-high (n=71, 23.6%) and mPAWP-low (n=230, 76.4%) based on the ultimate mPAWP value. Initial mPAWP clustered around median 12mmHg [8-14mmHg] in the mPAWP-high and 9mmHg [6-11mmHg] in the mPAWP-low trajectories (p<0.001). After feature selection, initial mPAWP ≥12mmHg predicted a mPAWP-high trajectory (odds ratio 3.2, 95% CI 1.4-6.1, p=0.0006). mPAWP-high trajectory was associated with shorter transplant-free survival (vs. mPAWP-low, median 7.8 vs. 11.3 years, log-rank p=0.017; age-adjusted p=0.217). CONCLUSIONS Over 10 years, the mPAWP followed two distinct trajectories, with 25% evolving into Group 2 PH physiology. Using routine baseline data, longitudinal mPAWP trajectory could be accurately predicted, with initial mPAWP ≥12mmHg as one of the strongest predictors.

中文翻译：

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平均肺动脉楔压轨迹对肺动脉高压的影响。

基本原理 平均肺动脉楔压 (mPAWP) 是区分 1 类肺动脉高压 (PAH) 和与左心疾病相关的 2 类肺动脉高压 (PH) 的关键血流动力学因素。尽管 mPAWP 生理正常上限与当前 PAH 定义之间存在差异，但初始 mPAWP 对 PAH 临床轨迹的影响尚不清楚。目的 对 10 年来 PAH 的纵向 mPAWP 轨迹进行建模，并检查与轨迹隶属关系相关的临床和血流动力学因素。方法 从马萨诸塞州东部的多机构医疗保健系统中筛选出进行过 2 次以上右心导管检查的成人 PAH 患者。mPAWP 轨迹是通过基于组的轨迹建模构建的。特征选择是在最小绝对收缩和选择算子回归中进行的。使用逻辑回归来评估轨迹成员资格、基线特征和无移植生存之间的关联。主要结果 在 301 名 PAH 患者中，有两种不同的 mPAWP 轨迹，根据最终 mPAWP 值称为 mPAWP 高（n=71，23.6%）和 mPAWP-低（n=230，76.4%）。初始 mPAWP 在 mPAWP 高轨迹中集中在中位数 12mmHg [8-14mmHg] 附近，在 mPAWP-低轨迹中集中在中位数 9mmHg [6-11mmHg] 附近 (p<0.001)。特征选择后，初始 mPAWP ≥12mmHg 预测 mPAWP 高轨迹（比值比 3.2，95% CI 1.4-6.1，p=0.0006）。mPAWP 高轨迹与较短的无移植生存相关（相对于 mPAWP 低，中位 7.8 年与 11.3 年，对数秩 p=0.017；年龄调整 p=0.217）。结论 10 年来，mPAWP 遵循两条不同的轨迹，其中 25% 演变为第 2 组 PH 生理学。使用常规基线数据，可以准确预测纵向 mPAWP 轨迹，初始 mPAWP ≥12mmHg 是最强的预测因子之一。