SPC365

Improving Risk Prediction in Pulmonary Hypertension: The Role of Pulmonary Arterial Compliance

Session: SESSÃO DE COMUNICAÇÕES ORAIS 02 – HIPERTENSÃO PULMONAR: DESENVOLVIMENTOS NA ESTRATIFICAÇÃO DE RISCO, DIAGNÓSTICO E TRATAMENTO
Speaker: Daniel Inácio Cazeiro

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: Daniel Inácio Cazeiro; Miguel Azaredo Raposo; Catarina Gregório; Ana Abrantes; Diogo Ferreira; Marta Vilela; João Cravo; Tatiana Guimarães; Susana Robalo Martins; Nuno Lousada; Fausto J. Pinto; Rui Plácido

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000"><strong>Introduction</strong></span></span><span style="font-size:11pt"><span style="color:#000000">:&nbsp;</span></span></span><br />
<span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#0e0e0e">Pulmonary arterial compliance (PAC) is an early marker of vascular disease in patients (pts) with pulmonary hypertension (PH), decreasing when pulmonary pressures and vascular resistance are still normal. Emerging evidence suggests that PAC may outperform traditional hemodynamic parameters as a predictor of outcomes in PH, potentially enhancing risk stratification in this population.</span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000"><strong>Objective</strong></span></span><span style="font-size:11pt"><span style="color:#000000">:&nbsp;</span></span></span><br />
<span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#0e0e0e">To evaluate the potential of PAC in predicting adverse outcomes in pts with PH, as an adjunct to conventional risk stratification models.</span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000"><strong>Methods</strong></span></span><span style="font-size:11pt"><span style="color:#000000">:&nbsp;</span></span></span><br />
<span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000">Single-center, retrospective study of pts with precapillary PH (groups I and IV) followed at a tertiary hospital. Risk stratification was initially performed using the COMPERA 2.0 four-strata risk stratification score.&nbsp;</span></span></span><br />
<span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000">Time-to-event analysis for a composite endpoint of all-cause death or hospitalization was conducted using Kaplan-Meier survival curves and Cox proportional hazards regression. A modified 4-strata risk score was developed to incorporate PAC. Pts with PAC values below the median advanced to the next risk category, except those at high risk, whose classification remained unchanged. The diagnostic performance of the traditional and modified models was compared using receiver operating characteristic (ROC) analysis.</span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000"><strong>Results</strong></span></span><span style="font-size:11pt"><span style="color:#000000">:</span></span></span><br />
<span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000">Seventy-one pts were included (mean age 58 years; 61% female; 55% with group I PH). In the conventional 4-strata score, 27%, 39%, 26% and 8% were at low, intermediate-low, intermediate-high and high risk, respectively.&nbsp;</span></span></span><br />
<span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000">Median PAC was 1.30 mL/mmHg. Pts with PAC below this value had a shorter time to the composite endpoint (hazard ratio [HR]:4.317, 95% confidence interval [CI]:1.423&ndash;13.095, p=0.01). Over a median follow-up time of 818 days, 17 combined events occurred. The COMPERA risk score demonstrated moderate predictive accuracy for events, with an area under the curve (AUC) of 69% (p=0.02); however, event rates were similar between intermediate-high and high-risk pts.&nbsp;</span></span></span><br />
<span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000">According to the modified 4-strata score, a significant shift of risk category was noted, especially in low (27&gt;15%) and high risk (8&gt;27%) categories. Pts who were at low risk did not experience any events, and a higher number of events occurred in pts at high risk. The accuracy of the modified score for predicting events was higher than the COMPERA risk score, with an AUC of 73% (p=0.005).</span></span></span></p>

<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000"><strong>Conclusion</strong></span></span><span style="font-size:11pt"><span style="color:#000000">:</span></span></span><br />
<span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000">In PH pts with a more adverse hemodynamic profile (defined as PAC &lt;1.30mL/mmHg), there was a higher risk to a combined endpoint of all-cause death or hospitalization. PAC may be used as a risk modifier in the conventional 4-strata risk score, providing a better accuracy for prediction of events. While our results provide new insight into risk stratification of PH pts, larger, prospective studies are needed to validate this hypothesis.</span></span></span></p>