Risk assessment in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension

Figures

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  FIGURE 1. Proportion of patients in each risk stratum at baseline and follow-up receiving a) riociguat and b) placebo in PATENT-1, and receiving c) riociguat and d) placebo in CHEST-1, according to the three abbreviated versions of the European Society of Cardiology (ESC)/European Respiratory Society (ERS) risk stratification model. Data may not add up to 100% due to rounding. Only patients who participated in PATENT-2 and CHEST-2 were included in the analysis. The analysis is based on observed data with no imputation. French registry invasive method: number of low-risk criteria fulfilled: 6-min walk distance (6MWD) >440 m, World Health Organization (WHO) functional class (FC) I/II, right atrial pressure (RAP) <8 mmHg and cardiac index ≥2.5 L·min−1·m−2. French registry non-invasive method: number of low-risk criteria fulfilled: 6MWD >440 m, WHO FC I/II and N-terminal pro-brain natriuretic peptide (NT-proBNP) <300 pg·mL−1. Swedish/COMPERA method: mean of grades (1–3: low, intermediate, high) of six available criteria (6MWD, WHO FC, NT-proBNP, RAP, cardiac index and mixed venous oxygen saturation) as defined in the ESC/ERS 2015 treatment guidelines, rounded to the nearest integer.

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  FIGURE 2. Forest plots comparing survival in PATENT-2 expressed as hazard ratios (95% CI) for mortality comparing patients who achieved one or more low-risk criteria compared with those who achieved no low-risk criteria at a) baseline and b) follow-up in PATENT-1, and clinical worsening-free survival in PATENT-2 expressed as hazard ratios (95% CI) for clinical worsening comparing patients who achieved one or more low-risk criteria compared with those who achieved no low-risk criteria at c) baseline and d) follow-up in PATENT-1. Only patients receiving riociguat 2.5 mg three times daily maximum in PATENT-1 who participated in PATENT-2 were considered in this analysis. French registry invasive method: number of low-risk criteria fulfilled: 6-min walk distance (6MWD) >440 m, World Health Organization (WHO) functional class (FC) I/II, right atrial pressure (RAP) <8 mmHg and cardiac index ≥2.5 L·min−1·m−2. French registry non-invasive method: number of low-risk criteria fulfilled: 6MWD >440 m, WHO FC I/II and N-terminal pro-brain natriuretic peptide (NT-proBNP) <300 pg·mL−1. Swedish/COMPERA method: mean of grades (1–3: low, intermediate, high) of six available criteria (6MWD, WHO FC, NT-proBNP,…

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  FIGURE 3. Kaplan–Meier curves for survival in patients based on risk stratification at PATENT-1 follow-up: a) French registry invasive method, b) French registry non-invasive method and c) Swedish/COMPERA method. Only patients receiving riociguat 2.5 mg three times daily maximum in PATENT-1 who participated in PATENT-2 were considered in this analysis. Data were based on observed cases with no imputation. Day 0=start of extension study. Only three patients were in the Swedish/COMPERA high-risk group at PATENT-1 follow-up and were therefore not included in the analysis for this method. French registry invasive method: number of low-risk criteria fulfilled: 6-min walk distance (6MWD) >440 m, World Health Organization (WHO) functional class (FC) I/II, right atrial pressure (RAP) <8 mmHg and cardiac index ≥2.5 L·min−1·m−2. French registry non-invasive method: number of low-risk criteria fulfilled: 6MWD >440 m, WHO FC I/II and N-terminal pro-brain natriuretic peptide (NT-proBNP) <300 pg·mL−1. Swedish/COMPERA method: mean of grades (1–3: low, intermediate, high) of six available criteria (6MWD, WHO FC, NT-proBNP, RAP, cardiac index and mixed venous oxygen saturation) as defined in the European…

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  FIGURE 4. Kaplan–Meier curves for clinical worsening-free survival in patients based on risk stratification at PATENT-1 follow-up: a) French registry invasive method, b) French registry non-invasive method and c) Swedish/COMPERA method. Only patients receiving riociguat 2.5 mg three times daily maximum in PATENT-1 who participated in PATENT-2 were considered in this analysis. Data were based on observed cases with no imputation. Day 0=start of extension study. Only three patients were in the Swedish/COMPERA high-risk group at PATENT-1 follow-up and were therefore not included in the analysis for this method. French registry invasive method: number of low-risk criteria fulfilled: 6-min walk distance (6MWD) >440 m, World Health Organization (WHO) functional class (FC) I/II, right atrial pressure (RAP) <8 mmHg and cardiac index ≥2.5 L·min−1·m−2. French registry non-invasive method: number of low-risk criteria fulfilled: 6MWD >440 m, WHO FC I/II and N-terminal pro-brain natriuretic peptide (NT-proBNP) <300 pg·mL−1. Swedish/COMPERA method: mean of grades (1–3: low, intermediate, high) of six available criteria (6MWD, WHO FC, NT-proBNP, RAP, cardiac index and mixed venous oxygen saturation) as…

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  FIGURE 5. Kaplan–Meier curves for survival in patients based on risk stratification at CHEST-1 follow-up: a) French registry invasive method, b) French registry non-invasive method and c) Swedish/COMPERA method. Only patients receiving riociguat 2.5 mg three times daily maximum in CHEST-1 who participated in CHEST-2 were considered in this analysis. Data were based on observed cases with no imputation. Day 0=start of extension study. Only five patients were in the Swedish/COMPERA high-risk group at CHEST-1 follow-up and were therefore not included in the analysis for this method. French registry invasive method: number of low-risk criteria fulfilled: 6-min walk distance (6MWD) >440 m, World Health Organization (WHO) functional class (FC) I/II, right atrial pressure (RAP) <8 mmHg and cardiac index ≥2.5 L·min−1·m−2. French registry non-invasive method: number of low-risk criteria fulfilled: 6MWD >440 m, WHO FC I/II and N-terminal pro-brain natriuretic peptide (NT-proBNP) <300 pg·mL−1. Swedish/COMPERA method: mean of grades (1–3: low, intermediate, high) of six available criteria (6MWD, WHO FC, NT-proBNP, RAP, cardiac index and mixed venous oxygen saturation) as defined in the European…

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  FIGURE 6. Kaplan–Meier curves for clinical worsening-free survival in patients based on risk stratification at CHEST-1 follow-up: a) French registry invasive method, b) French registry non-invasive method and c) Swedish/COMPERA method. Only patients receiving riociguat 2.5 mg three times daily maximum in CHEST-1 who participated in CHEST-2 were considered in this analysis. Data were based on observed cases with no imputation. Day 0=start of extension study. Only five patients were in the Swedish/COMPERA high-risk group at CHEST-1 follow-up and were therefore not included in the analysis for this method. French registry invasive method: number of low-risk criteria fulfilled: 6-min walk distance (6MWD) >440 m, World Health Organization (WHO) functional class (FC) I/II, right atrial pressure (RAP) <8 mmHg and cardiac index ≥2.5 L·min−1·m−2. French registry non-invasive method: number of low-risk criteria fulfilled: 6MWD >440 m, WHO FC I/II and N-terminal pro-brain natriuretic peptide (NT-proBNP) <300 pg·mL−1. Swedish/COMPERA method: mean of grades (1–3: low, intermediate, high) of six available criteria (6MWD, WHO FC, NT-proBNP, RAP, cardiac index and mixed venous oxygen saturation) as…

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  FIGURE 7. Forest plots comparing survival in CHEST-2 expressed as hazard ratios (95% CI) for mortality comparing patients who achieved one or more low-risk criteria compared with those who achieved no low-risk criteria at a) baseline and b) follow-up in CHEST-1, and clinical worsening-free survival in CHEST-2 expressed as hazard ratios (95% CI) for clinical worsening comparing patients who achieved one or more low-risk criteria compared with those who achieved no low-risk criteria at c) baseline and d) follow-up in CHEST-1. Only patients receiving riociguat 2.5 mg three times daily maximum in CHEST-1 who participated in CHEST-2 were considered in this analysis. French registry invasive method: number of low-risk criteria fulfilled: 6-min walk distance (6MWD) >440 m, World Health Organization (WHO) functional class (FC) I/II, right atrial pressure (RAP) <8 mmHg and cardiac index ≥2.5 L·min−1·m−2. French registry non-invasive method: number of low-risk criteria fulfilled: 6MWD >440 m, WHO FC I/II and N-terminal pro-brain natriuretic peptide (NT-proBNP) <300 pg·mL−1. Swedish/COMPERA method: mean of grades (1–3: low, intermediate, high) of six available criteria (6MWD, WHO FC, NT-proBNP, RAP,…