Risk prediction in pulmonary hypertension due to chronic heart failure: incremental prognostic value of pulmonary hemodynamics

Ruilin Quan, Shian Huang, Lingpin Pang, Jieyan Shen, Weifeng Wu, Fangming Tang, Xiulong Zhu, Weiqing Su, Jingzhi Sun, Zaixin Yu, Lemin Wang, Xianyang Zhu, Changming Xiong, Jianguo He, Ruilin Quan, Shian Huang, Lingpin Pang, Jieyan Shen, Weifeng Wu, Fangming Tang, Xiulong Zhu, Weiqing Su, Jingzhi Sun, Zaixin Yu, Lemin Wang, Xianyang Zhu, Changming Xiong, Jianguo He

Abstract

Background: There is no generally accepted comprehensive risk prediction model cooperating risk factors associated with heart failure and pulmonary hemodynamics for patients with pulmonary hypertension due to left heart disease (PH-LHD). We aimed to explore outcome correlates and evaluate incremental prognostic value of pulmonary hemodynamics for risk prediction in PH-LHD.

Methods: Consecutive patients with chronic heart failure undergoing right heart catheterization were prospectively enrolled. The primary endpoint was all-cause mortality. Individual variable selection was performed by machine learning methods. Cox proportional hazards models were conducted to identify the association between variables and mortality. Incremental value of hemodynamics was evaluated based on the Seattle heart failure model (SHFM) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) scores.

Results: A total of 276 PH-LHD patients were enrolled, with a median follow-up time of 34.7 months. By L1-penalized regression model and random forest approach, diastolic pressure gradient (DPG) and mixed venous oxygen saturation (SvO2) were the hemodynamic predictors most strongly associated with mortality (coefficient: 0.0255 and -0.0176, respectively), with consistent significance after adjusted for SHFM [DPG: HR 1.067, 95% CI 1.024-1.113, P = 0.022; SvO2: HR 0.969, 95% CI 0.953-0.985, P = 0.002] or MAGGIC (DPG: HR 1.069, 95% CI 1.026-1.114, P = 0.011; SvO2: HR 0.970, 95% CI 0.954-0.986, P = 0.004) scores. The inclusion of DPG and SvO2 improved risk prediction compared with using SHFM [net classification improvement (NRI): 0.468 (0.161-0.752); integrated discriminatory index (IDI): 0.092 (0.035-0.171); likelihood ratio test: P < 0.001] or MAGGIC [NRI: 0.298 (0.106-0.615); IDI: 0.084 (0.033-0.151); likelihood ratio: P < 0.001] scores alone.

Conclusion: In PH-LHD, pulmonary hemodynamics can provide incremental prognostic value for risk prediction.

Clinical trial registration: NCT02164526 at https://clinicaltrials.gov .

Keywords: Heart failure; Pulmonary hemodynamics; Pulmonary hypertension; Risk prediction; Survival.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Patient dispositions. CHF: chronic heart failure; RHC: right heart catheterization; PH: pulmonary hypertension
Fig. 2
Fig. 2
The variable importance plot based on the random forest classifier with the indicator of “all-cause mortality” as the dependent variable. DPG: diastolic pressure gradient; SvO2: mixed venous oxygen saturation; NYHA-FC: New York Heart Association functional class; RVSP: right ventricular systolic pressure; MPAP: mean pulmonary artery pressure; NTpro-BNP: N-terminal pro b-type natriuretic peptide; BUN: blood urea nitrogen; PAC: pulmonary arterial compliance; BMI: body mass index; SBP: systolic blood pressure; MRA: mineralocorticoid receptor antagonist; CHD: coronary heart disease; ARB: angiotensin-receptor blockers; PAWP: pulmonary arterial wedge pressure; LVEF: left ventricular ejection fraction; PVR: pulmonary vascular resistance; CCB: Ca2 + channel blockers
Fig. 3
Fig. 3
Multivariate Cox hazard proportional models for all-cause mortality. A SHFM + hemodynamics as continuous variables; B MAGGIC + hemodynamics as continuous variables; C SHFM + hemodynamics as dichotomous variables; D MAGGIC + hemodynamics as dichotomous variables. DPG: diastolic pressure gradient; SvO2: mixed venous oxygen saturation; SHFM: the Seattle heart failure model; MAGGIC: Meta-Analysis Global Group in Chronic Heart Failure

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Source: PubMed

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