Can Follow-up Hemodynamic Variables Predict Outcome in PAH?

Measured at the time of diagnosis, hemodynamic variables such as cardiac index and right atrial pressure have been consistently associated with survival in in pulmonary arterial hypertension (PAH). Much less clear is the predictive power of hemodynamic values achieved after initial treatment of PAH.

This short slide show provides a top-line review of a recent study that evaluated the prognostic importance of clinical and hemodynamic variables during the first follow-up assessment after management of PAH had begun.

Predicting death and transplant in PAH.  Few studies have looked at prognostic utility of hemodynamic variables after starting therapy PAH.

First follow-up hemodynamics: What predictive value? First follow-up RHC measured RAP, CI, PCa, stroke volume index (SVI), pulmonary vascular resistance (PVR)
 

SVI, RAP Strongest Predictors of Death or Transplant. First follow-up RHC: Lower SVI and higher RAP were the only hemodynamic variables independently associated with death or transplant.

PCa not an Independent Predictor. SVI had greater predictive value than CI or PCa; lower SVI identified at risk patients even when they had ≥ 2 low risk prognostic features.

Optimal Cutpoints at First follow-up RHC.

Among Study Limitations: Analysis only included 763 of 981 patients due to lack of follow-up or missing data; possible selection bias: some patients excluded because they died or were transplanted before first RHC follow-up.

Author's: SVI May be Better Target than CI. "...stroke volume index could be a better hemodynamic variable to monitor in prognostication and to consider as a PAH treatment target than the cardiac index..." 

Take-home Points include: PCa did not independently predict outcomes at baseline or follow-up. Lower SVI identified patients at higher risk of death or lung transplant, even when they had low risk features according to international guidelines.