A simple equal-weighted clinical risk score effectively stratified patients with post-operative pulmonary hypertension into distinct survival groups for cardiovascular events (HR 3.61; p<0.001).
Cohort (n=84)
Yes
Can a simple clinical risk score predict cardiovascular events in patients with post-operative pulmonary hypertension following biventricular repair of congenital heart disease?
A simple, equal-weighted risk score based on hemodynamics, natriuretic peptides, and functional class effectively stratifies mid-term cardiovascular risk in patients with post-operative pulmonary hypertension after congenital heart disease repair.
Effect estimate: HR 3.61
p-value: p=<0.001
Post-operative pulmonary hypertension (PH) following biventricular repair of congenital heart disease (CHD) remains a high-risk condition, but its prognosis and risk stratification are poorly defined. This study aimed to identify prognostic factors and develop a simple clinical risk score. Patients with post-operative PH enrolled in the Japan CHD–Pulmonary Hypertension Registry (2021–2024) were analyzed. Continuous and categorical variables were assessed by log-rank testing, and a composite risk score was developed to predict cardiovascular events. Prognostic performance was evaluated by Kaplan–Meier and Cox regression analyses. Among 84 patients (median age 11.6 years; 55% men), eight cardiovascular events occurred during a mean follow-up of 18.2 months: three all-cause deaths, three hospitalizations for heart failure, and two cases of worsening functional class. Mean pulmonary artery pressure ≥ 30 mmHg, pulmonary vascular resistance index ≥4.0 WU·m 2 , B-type natriuretic peptide ≥40 pg/mL or NT-proBNP ≥300 pg/mL, and WHO functional class ≥III were significant prognostic factors. An equal-weighted score (0–4 points) stratified patients into low- (0–1), moderate- (2–3), and high-risk (4) groups with distinct survival (hazard ratio, 3.61; p < 0.001). This nationwide, registry-based study provides new insights into prognostic determinants and risk stratification in patients with post-operative PH. This study identified practical prognostic factors and proposed a simple, exploratory equal-weighted risk score. Prognostic significance was evident even at thresholds below conventional criteria, highlighting the vulnerability of this population and supporting the score's potential clinical utility pending external validation. • Post-operative pulmonary hypertension (PH) after biventricular repair of congenital heart disease (CHD) is a rare but serious condition with poor outcomes, however, its prognostic determinants remain largely unclear. • Registry-based studies specifically evaluating prognostic determinants and risk stratification in post-operative CHD-PH remain limited. • It identified practical hemodynamic and clinical predictors and developed a simple, exploratory risk score that effectively stratified event-free survival despite a limited number of events. • The findings emphasize the prognostic significance of even mild hemodynamic abnormalities in post-operative PH and support early postoperative risk assessment. • The proposed risk score may serve as a framework for future multicenter validation and personalized management strategies in this high-risk population.
Sumitomo et al. (Wed,) conducted a cohort in Post-operative pulmonary hypertension following biventricular repair of congenital heart disease (n=84). Equal-weighted clinical risk score vs. Low, moderate, and high-risk groups was evaluated on Cardiovascular events (all-cause death, hospitalization for heart failure, worsening functional class) (HR 3.61, p=<0.001). A simple equal-weighted clinical risk score effectively stratified patients with post-operative pulmonary hypertension into distinct survival groups for cardiovascular events (HR 3.61; p<0.001).