This article is part of Pulmonology Advisor‘s coverage of the American Thoracic Society International Conference, taking place in Dallas, Texas. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2019.


DALLAS — Echocardiographic right atrial (RA) area improved the risk stratification of a simplified risk assessment tool designed to predict survival in patients with pulmonary arterial hypertension (PAH). This is according to study findings presented at the American Thoracic Society International Conference held May 17-22, in Dallas, Texas.

A total of 461 treatment-naive patients with inheritable/idiopathic-PAH, connective tissue disease-PAH, and congenital heart disease-PAH who presented to a single center in Italy between 2003 and 2017 were enrolled in the study. Patients underwent a simplified risk assessment that considered their World Health Organization functional class, 6-minute walking distance, RA pressure or plasma levels of brain natriuretic peptide (BNP), and cardiac index (CI) or mixed venous oxygen saturation (SvO2). The worst parameter was chosen from the last 2 risk assessment criteria. Based on assessment, the patients were categorized as low risk (≥3 low-risk and no high-risk criteria), high risk (≥2 high-risk criteria, including CI or SvO2), or intermediate risk (low- or high-risk criteria not fulfilled).

A Cox analysis was performed to investigate the echocardiographic predictors of survival, and these independent predictors were added to the simplified risk assessment to determine their effect on improving risk stratification.


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Independent echocardiographic predictors of survival included RA area (hazard ratio [HR], 1.028; 95% CI, 1.012-1.045; P =.001), severity of tricuspid regurgitation (HR, 1.013; 95% CI, 1.006-1.021; P =.001), and the presence of pericardial effusion (HR, 1.533; 95% CI, 1.142-2.057; P =.004). However, the only predictor that improved risk stratification of the validated simplified PAH risk table was RA area (likelihood ratio of the chi-square increased from 63.8 to 68.1; likelihood ratio test=0.039).

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A second risk table was developed by the researchers as a result of the observed association between RA area and RA pressure (r=0.470; P <.001), as well as BNP (r=0.372; P =.004). The risk table combined RA area, RA pressure, and BNP, of which the worst parameter of the 3 factors was considered. The risk stratification improved with the inclusion of RA area (likelihood ratio chi-square increased from 63.8 to 72.7; Akaike Information Criterion/Bayes Information Criterion decreased from 1956/1964 to 1947/1955).

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Reference

Dardi F, Manes A, Palazzini M, et al. Additional role of echocardiogram in pulmonary arterial hypertension risk stratification according to current ESC/ERS guidelines. Presented at: the American Thoracic Society International Conference; May 20, 2019; Dallas, TX. Abstract A3651/P996.