REVEAL 2.0 and COMPERA risk scores discriminated mortality risk in PH-LHD, despite significant 3-year mortality differences between the two cohorts (20% vs 6%; OR 3.9, 95% CI 1.4-10.7).
Cohort (n=244)
Sí
Do existing PAH risk stratification scores (REVEAL 2.0 and COMPERA) accurately predict mortality in patients with pulmonary hypertension secondary to left heart disease?
Existing PAH risk scores (REVEAL 2.0, COMPERA) can discriminate mortality risk in PH-LHD, but significant inter-model discordance highlights the need for a dedicated PH-LHD risk model.
Estimación del efecto: OR 3.9 (95% CI 1.4-10.7)
Tasa de eventos absoluta: 20% vs 6%
valor p: p=0.007
Abstract Background Pulmonary hypertension due to left heart disease (PH-LHD) is common and associated with poor outcomes. However, validated mortality risk prediction tools for PH-LHD remain lacking. It remains unclear whether existing risk models developed for pulmonary arterial hypertension, such as REVEAL 2.0 or COMPERA, are applicable to PH-LHD. Methods We retrospectively analyzed two independent cohorts of patients with PH-LHD: 161 patients referred to University of Cincinnati PH center between 2016-2022 (Cohort A) and 83 referred to Amsterdam University Medical Center (Cohort B). Risk stratification was performed using REVEAL 2.0, COMPERA 3-strata, and COMPERA 4-strata scores. Agreement among models was evaluated using confusion matrices. Survival at 1 and 3 year was assessed using Kaplan-Meier analysis and Cox proportional hazards models. Principal component analysis (PCA) was applied to identify REVEAL 2.0 components most strongly contributing to risk differentiation. Results The two cohorts differed significantly in comorbidities, NYHA functional class distribution, six-minute walk distance (6MWD, 244 m vs 433 m, p 0.001), NT-proBNP levels (782 pg/mL vs 128 pg/mL, p 0.001), mean pulmonary artery pressure (35 mmHg vs 22 mmHg, p 0.001), and 3-years mortality (20% vs 6%, χ² = 7.27, p = 0.007; OR = 3.9 95 % CI 1.4-10.7). Discordance was observed among the risk scores (Figure A): REVEAL 2.0 classified 43%, 22%, and 35% of patients as low, intermediate, and high risk, respectively, whereas COMPERA 3-strata classified 33%, 62%, and 6%. COMPERA 4-strata classified more patients as intermediate risk category (40% as low-intermediate and 43% as high-intermediate) compared to COMPERA 3-strata. Despite these discrepancies, all models successfully discriminated mortality risk across strata (Figure B). PCA of REVEAL 2.0 components identified NTproBNP, GFR, NYHA functional class, and 6MWD as the top four contributors to risk separation, however significant overlap was seen between the three risk strata (Figure C). Conclusion Differences in baseline characteristics and survival among two different cohorts of PH-LHD highlight disease heterogeneity and possible practice-pattern variations across centers and countries. While existing PAH-based tools (REVEAL 2.0 and COMPERA) demonstrated prognostic value in PH-LHD, inter-model and inter-cohort discordance underscore the need for a dedicated PH-LHD risk model. Risk score with weight on NT-proBNP, GFR, NYHA class, and 6MWD may enhance future risk prediction frameworks tailored to this population. This abstract is funded by: None
Ichimura et al. (Fri,) conducted a cohort in Pulmonary hypertension due to left heart disease (PH-LHD) (n=244). REVEAL 2.0, COMPERA 3-strata, and COMPERA 4-strata scores was evaluated on 3-years mortality (OR 3.9, 95% CI 1.4-10.7, p=0.007). REVEAL 2.0 and COMPERA risk scores discriminated mortality risk in PH-LHD, despite significant 3-year mortality differences between the two cohorts (20% vs 6%; OR 3.9, 95% CI 1.4-10.7).
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