This article is part of Pulmonology Advisor‘s coverage of the CHEST 2019 meeting, taking place in New Orleans, LA. Our staff will report on medical research related to asthma, COPD, critical care medicine, and more conducted by experts in the field. Check back regularly for more news from CHEST 2019.


NEW ORLEANS — Clinical experts in pulmonary arterial hypertension (PAH) identified hemodynamic variables as predictive of patient survival that were different from variables found in major clinical trials,  according to study results presented at CHEST 2019, held October 19 to 23, 2019, in New Orleans, Louisiana.

A total of 10 clinical experts in PH were asked to participate in this study. Participants discussed hemodynamic variables they perceived as having an effect on survival in patients with PAH. All hemodynamic variables discussed were based on clinician experience. While these discussions were taking place, researchers performed a Cox regression analysis on baseline hemodynamic parameters in patients with PAH from several clinical trials (n=2802). These trials included SERAPHIN, BREATHE-1, PATENT, CHEST, and the pivotal treprostinil trial.

Clinical experts discussed 14 hemodynamic variables perceived as impacting survival in PAH, resulting in a total of 26 variables after inclusion of the hemodynamic parameters from the trials. The hemodynamic variables predictive of survival that were most discussed by the experts included cardiac index (aggregated P =.0007), right atrial pressure (aggregated P =.0003), and mean pulmonary artery pressure (aggregated P =.073). The hemodynamic parameters most predictive of survival in the clinical trials, however, included stroke volume, stroke work index, and stroke work (all P <.000).

“Clinical gestalt” alone may underestimate evidence-based hemodynamics in predicting patient mortality risk in PAH, the researchers noted. “Therefore, the role of methodical risk stratification based on evidence-based risk assessment cannot be overemphasized.”

They added that findings from their analysis will be used to select features for derivation of a machine-learned patient risk stratification tool.

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Scott J, Lohmueller L, Kraisangka J, Kanwar M, Benza R. Hemodynamic parameters in predicting survival in pulmonary arterial hypertension. Presented at: CHEST Annual Meeting 2019; October 19-23, 2019; New Orleans, LA. Abstract 1174.