Simplified risk stratification based on cardiopulmonary exercise test: A Spanish two-center experience.

Autor: Martínez-Meñaca A; Respiratory Department, ERN-LUNG (European Reference Network on rare respiratory diseases), Instituto de Investigación Valdecilla (IDIVAL) Hospital Universitario Marqués de Valdecilla Santander Spain., Cruz-Utrilla A; Cardiology Department, ERN-LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid Spain., Mora-Cuesta VM; Respiratory Department, ERN-LUNG (European Reference Network on rare respiratory diseases), Instituto de Investigación Valdecilla (IDIVAL) Hospital Universitario Marqués de Valdecilla Santander Spain., Luna-López R; Cardiology Department, ERN-LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid Spain., Segura-de la Cal T; Cardiology Department, ERN-LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid Spain., Flox-Camacho Á; Cardiology Department, ERN-LUNG (European Reference Network on rare respiratory diseases) Hospital Universitario Doce de Octubre Madrid Spain., Alonso-Lecue P; IDIVAL (Valdecilla Research Institute) Santander Spain., Escribano-Subias P; Cardiology Department, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III (ISCIII) Hospital Universitario Doce de Octubre Madrid Spain.; ERN-LUNG (European Reference Network on rare respiratory diseases), Facultad de Medicina Universidad Complutense de Madrid Madrid Spain., Cifrián-Martínez JM; Respiratory Department, ERN-LUNG (European Reference Network on rare respiratory diseases), Instituto de Investigación Valdecilla (IDIVAL) Facultad de Medicina, Hospital Universitario Marqués de Valdecilla Universidad de Cantabria Santander Spain.
Jazyk: angličtina
Zdroj: Pulmonary circulation [Pulm Circ] 2024 Feb 27; Vol. 14 (1), pp. e12342. Date of Electronic Publication: 2024 Feb 27 (Print Publication: 2024).
DOI: 10.1002/pul2.12342
Abstrakt: A simplified 4-strata risk stratification approach based on three variables is widespread in pulmonary arterial hypertension (PAH) at follow-up. This study aimed to assess the impact of replacing the 6-min walk test (6MWT) with the peak 0 2 uptake evaluated by the cardiopulmonary exercise test (CPET) on risk stratification by this scale. We included 180 prevalent patients with PAH from two reference hospitals in Spain, followed up between 2006 and 2022. Patients were included if all the variables of interest were available within a 3-month period on the Spanish Registry of Pulmonary Arterial Hypertension (REHAP): functional class (FC); NT-proBNP; 6MWT; and CPET. The original 4-strata model (NT-proBNP, 6MWT, FC) identified most patients at low or intermediate-low risk (36.7% and 51.1%, respectively). Notably, the modified scale (NT-proBNP, CPET, FC) improved the identification of patients at intermediate-high risk up to 18.9%, and at high risk up to 1.1% in comparison with the previous 12.2% and 0.0% in the original scale. This new model increased the number of patients correctly classified into higher-risk strata (positive NRI of 0.06), as well as classified more patients without events in lower-risk strata (negative NRI of 0.04). The proposed score showed a slightly superior prognostic capacity compared with the original model (Harrel's C-index 0.717 vs. 0.709). Using O 2 uptake instead of distance walked in the 6MWT improves the identification of high-risk patients using the 4-strata scale. This change could have relevant prognostic implications and lead to changes in the specific treatment of PAH.
Competing Interests: The authors declare no conflict of interest.
(© 2024 The Authors. Pulmonary Circulation published by John Wiley & Sons Ltd on behalf of Pulmonary Vascular Research Institute.)
Databáze: MEDLINE
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