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A New Score to Differentiate Idiopathic Pulmonary Arterial Hypertension from Pulmonary Hypertension Due to Heart Failure with Preserved Ejection Fraction
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A4387 - A New Score to Differentiate Idiopathic Pulmonary Arterial Hypertension from Pulmonary Hypertension Due to Heart Failure with Preserved Ejection Fraction
Author Block: F. Dardi1, N. Tanese1, S. Caravita2, A. Rinaldi1, C. Dewachter3, E. Gotti1, T. Nguyen3, E. Monti1, A. Albini1, M. Palazzini1, A. Manes1, J. E. Vachiery3, N. Galié1; 1Cardiology, University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES, Bologna, Italy, 2Cardiologia, IRCCS Ospedale S. Luca, Milano, Italy, 3Cardiology, Pulmonary Hypertension and Heart Failure Clinic - CUB Hopital Erasme, Brussels, Belgium.
RATIONALE: the distinction between pulmonary hypertension (PH) due to heart failure with preserved ejection fraction (PH-HFpEF) and idiopathic/heritable pulmonary arterial hypertension (I/H-PAH) is mainly based on a pulmonary artery wedge pressure (PAWP) >15 mmHg in the former. However, pseudo-normalization of PAWP by diuretic treatment cannot be excluded in selected PH-HFpEF patients. The aim of the study is to elaborate a composite clinical score that may help identifying HFpEF as the cause of PH in patients with a borderline-low PAWP (13 to 15 mmHg).
METHODS: baseline data were derived from the retrospective analysis of prospective PH patient registries of Bologna (score-Derivation cohort) and Brussels (score-Validation cohort) PH centres. Consecutive incident and PAH approved drugs-naïve patients with I/H-PAH or PH-HFpEF were included from January 1st 2003 to July 31st 2016 in both centres. The final correct diagnosis of I/H-PAH and PH-HFpEF was also based on follow-up data. Univariate and multivariate logistic regression analysis of the baseline data of the Derivation cohort was performed. Using the fully adjusted regression coefficients of this model an integer risk score was generated, as described by Sullivan et al.
RESULTS: the Derivation cohort included 408 patients, 322 with I/H-PAH and 86 with PH-HFpEF. At the multivariate logistic regression analysis age, body mass index (BMI), history of high blood pressure or atrial fibrillation, pulmonary arterial compliance, QRS and T axes and ECG criteria for left ventricular hypertrophy were identified as predictors of PH-HFpEF. The score derived from this model was tested in the 26 patients with borderline-low PAWP of the Derivation cohort and a cut-off of ≥13 points yielded a specificity of 95% and a sensitivity of 100% for the diagnosis of PH-HFpEF. The same cut-off score tested in the Validation cohort of 30 patients with borderline-low PAWP yielded a specificity and a sensitivity of 100% for the correct diagnosis of PH-HFpEF.
CONCLUSIONS: a predictive score incorporating age, BMI, cardiovascular history, electrocardiographic and haemodynamic data can be utilised in differentiating I/H-PAH patients from PH-HFpEF with borderline-low PAWP.
Author Block: F. Dardi1, N. Tanese1, S. Caravita2, A. Rinaldi1, C. Dewachter3, E. Gotti1, T. Nguyen3, E. Monti1, A. Albini1, M. Palazzini1, A. Manes1, J. E. Vachiery3, N. Galié1; 1Cardiology, University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES, Bologna, Italy, 2Cardiologia, IRCCS Ospedale S. Luca, Milano, Italy, 3Cardiology, Pulmonary Hypertension and Heart Failure Clinic - CUB Hopital Erasme, Brussels, Belgium.
RATIONALE: the distinction between pulmonary hypertension (PH) due to heart failure with preserved ejection fraction (PH-HFpEF) and idiopathic/heritable pulmonary arterial hypertension (I/H-PAH) is mainly based on a pulmonary artery wedge pressure (PAWP) >15 mmHg in the former. However, pseudo-normalization of PAWP by diuretic treatment cannot be excluded in selected PH-HFpEF patients. The aim of the study is to elaborate a composite clinical score that may help identifying HFpEF as the cause of PH in patients with a borderline-low PAWP (13 to 15 mmHg).
METHODS: baseline data were derived from the retrospective analysis of prospective PH patient registries of Bologna (score-Derivation cohort) and Brussels (score-Validation cohort) PH centres. Consecutive incident and PAH approved drugs-naïve patients with I/H-PAH or PH-HFpEF were included from January 1st 2003 to July 31st 2016 in both centres. The final correct diagnosis of I/H-PAH and PH-HFpEF was also based on follow-up data. Univariate and multivariate logistic regression analysis of the baseline data of the Derivation cohort was performed. Using the fully adjusted regression coefficients of this model an integer risk score was generated, as described by Sullivan et al.
RESULTS: the Derivation cohort included 408 patients, 322 with I/H-PAH and 86 with PH-HFpEF. At the multivariate logistic regression analysis age, body mass index (BMI), history of high blood pressure or atrial fibrillation, pulmonary arterial compliance, QRS and T axes and ECG criteria for left ventricular hypertrophy were identified as predictors of PH-HFpEF. The score derived from this model was tested in the 26 patients with borderline-low PAWP of the Derivation cohort and a cut-off of ≥13 points yielded a specificity of 95% and a sensitivity of 100% for the diagnosis of PH-HFpEF. The same cut-off score tested in the Validation cohort of 30 patients with borderline-low PAWP yielded a specificity and a sensitivity of 100% for the correct diagnosis of PH-HFpEF.
CONCLUSIONS: a predictive score incorporating age, BMI, cardiovascular history, electrocardiographic and haemodynamic data can be utilised in differentiating I/H-PAH patients from PH-HFpEF with borderline-low PAWP.
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