Key result
Baseline pericardial effusion linked to ~230% higher mortality risk in pulmonary arterial hypertension.
Why the study?
The prognosis and prognostic factors in pulmonary arterial hypertension patients in real-world medical practice in the Tokai area in Japan were unclear.
Observational (n=81)
Yes
The presence of pericardial effusion, elevated mean right atrial pressure, or a cardiac index <2.5 L/min/m2 at diagnosis are independent predictors of high mortality in patients with pulmonary arterial hypertension.
Pericardial effusion at PAH diagnosis signals higher mortality risk; hypothesis-generating for risk stratification and requires prospective validation.
AIMS: To clarify the prognosis and prognostic factors in pulmonary arterial hypertension (PAH) patients in real-world medical practice in the Tokai area in Japan. MAIN METHODS: We conducted a retrospective, multicenter observational study. The data of 81 patients diagnosed with Dana Point group 1 or 1' PAH was collected from January 2005 to January 2013. The primary outcome was all-cause death. KEY FINDINGS: The patients consisted of 34 cases of idiopathic PAH (IPAH), 28 of connective tissue-associated PAH (CTD-PAH), 16 of congenital heart disease-associated PAH (CHD-PAH) and others. Mean age was 51 years and mean observation period was 46 months. The systolic blood pressure (BPs) was 117±23 mm Hg. Pericardial effusion was observed in 27.0% of patients. The mean right atrial pressure (mRAP) was 10.2±7.3 mm Hg. In the univariate Cox regression analysis, WHO-FCS III & IV, a cardiac index (CI)<2.5 L/min/m(2), and the presence of pericardial effusion at baseline were significantly associated with all-cause death. In the multivariate analysis, the pericardial effusion (HR 3.3, 95% CI 1.03-10.63, p=0.04) and mRAP (HR 3.2, 95% CI 1.03-9.83, p=0.04) or CI<2.5 L/min/m(2) (HR 3.89, 95% CI 1.05-14.45, p=0.04) were the independent predictors of mortality. SIGNIFICANCE: The presence of pericardial effusion and mRAP or CI<2.5 L/min/m(2) at diagnosis indicated high mortality.
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Adachi et al. (2014) conducted an observational in pulmonary arterial hypertension (PAH) (n=81). Pericardial effusion vs. Absence of pericardial effusion was evaluated on all-cause death (HR 3.3, 95% CI 1.03-10.63, p=0.04). Baseline pericardial effusion was an independent predictor of all-cause mortality in patients with pulmonary arterial hypertension (HR 3.3; 95% CI 1.03-10.63; p=0.04).
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