| Part 1 Predictive Effect of Tricuspid Regurgitation for All-Cause Mortality in Patients with Pulmonary Arterial HypertensionObjectives:To explore the predictive effect of tricuspid regurgitation(TR)degree for allcause mortality in patients with pulmonary arterial hypertension(PAH).Methods:PAH patients hospitalized in Fuwai Hospital from April 2019 to March 2022 were retrospectively enrolled.According to the degree of TR,the patients were divided into TR-non/micro/mild group,TR-moderate group and TR-severe group.Multivariate ordered Logistic regression was used to analyze the influencing factors of TR degree.The follow-up was conducted by telephone,and the study endpoint was defined as allcause mortality.Kaplan-Meier analysis was used to calculate the survival rate,and logrank trend test was used to analyze the prognosis of the three groups.Multivariate Cox proportional hazards regression was used to analyze the correlation between TR and the prognosis of PAH patients.Prediction accuracy was evaluated by C-index and calibration curve,and decision curve analysis was performed.Results:A total of 1132 patients with PAH were enrolled.The median age was 35(28,48)years,and 839 cases(74.1%)were females.There were 457 cases(40.4%)in TRnon/micro/mild group,403 cases(35.6%)in TR-moderate group,and 272 cases(24.0%)in TR-severe group.Multivariate Logistic regression analysis showed age,female,right ventricular anteroposterior diameter and pulmonary vascular resistance were positively correlated with TR degree,while body mass index and tricuspid annular plane systolic excursion was negatively correlated with TR degree(all P<0.05).During a median follow-up of 1.9(1.1,2.8)years,115(10.2%)patients died.The incidence of all-cause mortality in TR-non/micro/mild group,TR-moderate group and TR-severe group was 3.3%(15/457),9.4%(38/403)and 22.8%(62/272),respectively.The rates of all-cause mortality were significantly increased with strata rising(x2=75.728,P<0.001).Multivariate Cox proportional hazards regression showed that compared with TRnon/micro/mild group,TR-moderate group(HR=1.949,95%CI:1.008～3.766,P=0.047)and TR-severe group(HR=3.095,95%CI:1.488～6.441,P=0.003)had a significantly increased risk of all-cause mortality.The degree of TR had a good predictive ability for 2-year mortality in patients with PAH(C-index=0.714).Calibration curves exhibited good agreement between observed and predicted survival.Decision curves indicated clinical utility.Conclusions:The degree of TR can be used to predict the risk of all-cause mortality in PAH patients.Part 2 Relationship between Tricuspid Regurgitation Degree and Abnormal Liver Function in Patients With Pulmonary Arterial HypertensionObjectives:To clarify the type of liver dysfunction in pulmonary arterial hypertension(PAH),its relation to tricuspid regurgitation,and its correlation with prognosis.Methods:PAH patients hospitalized in Fuwai Hospital from April 2019 to March 2022 were retrospectively enrolled.The follow-up was conducted by telephone,and the study endpoint was defined as all-cause mortality.Multivariate logistic regression was used to analyze the influence of cardiac parameters on liver dysfunction.And multivariate Cox proportional hazards regression was used to analyze the correlation between liver dysfunction and the prognosis of PAH patients.Results:A total of 1112 patients with PAH were included.The median age was 35(28,47)years.825 cases(74.2%)were female.The liver function abnormalities in PAH patients were mainly presented with decreased serum albumin(38.9%),increased total bilirubin(35.3%),increased direct bilirubin(30.5%)and increased glutamyl transpeptidase(21.7%).Multivariate Logistic regression analysis showed that moderate and severe tricuspid regurgitation,tricuspid annular plane systolic excursion(TAPSE)and mean right atrial pressure were independent risk factors for decreased serum albumin(all P<0.05).Severe tricuspid regurgitation,right ventricular anterior-posterior diameter(RVAPD)and TAPSE were independent risk factors for elevated serum total bilirubin(all P<0.05).Severe tricuspid regurgitation,RVAPD and TAPSE were independent risk factors for elevated serum direct bilirubin(all P<0.05).Moderate and severe tricuspid regurgitation,RVAPD,TAPSE,mean right atrial pressure and cardiac index were independent risk factors for increased glutamyl transpeptidase(all P<0.05).Multivariate Cox proportional hazards regression showed that serum albumin level(HR=0.924,95%CI:0.889～0.960,P<0.001)and total bilirubin(HR=1.024,95%CI:1.011～1.037,P<0.001)were independent risk factors for all-cause mortality in PAH patients.Conclusions:Serum albumin and total bilirubin level were independent risk factors for all-cause mortality in patients with PAH.Moderate and severe tricuspid regurgitation were independently associated with decreased serum albumin.Severe tricuspid regurgitation was independently associated with increased serum total bilirubin.Part 3 Predictive Value of Modified Model for End-stage Liver Disease for AllCause Mortality in Patients with Pulmonary Arterial HypertensionObjectives:To explore the predictive effect of modified model for end-stage liver disease with albumin replacing international normalized ratio(MELD-Alb)for all-cause mortality in patients with pulmonary arterial hypertension(PAH).Methods:PAH patients hospitalized in Fuwai Hospital from April 2019 to March 2022 were retrospectively enrolled and randomly assigned into train-cohort and test-cohort.The patients were separated in high-score group(≥10.67)and low-score group(<10.67)according to the cut-off point of MELD-Alb score in train-cohort.Kaplan-Meier analysis was used to calculate the survival rate.Multivariate Cox proportional hazards regression was used to analyze the correlation between high MELD-Alb scores and the prognosis of PAH patients.Prediction accuracy was evaluated by C-index and calibration curve,and decision curve analysis was performed.Results:A total of 1112 patients with PAH were enrolled.The median age was 35(28,47)years.825 cases(74.2%)were female.778 cases were assigned in the train-cohort and 334 cases in the test-cohort.During a median follow-up of 1.9(1.1,2.8)years,84(10.8%)patients died in the train-cohort.The all-cause mortality was 27.2%(47/173)and 6.1%(37/605)in the high-score group and low-score group,respectively.Kaplan-Meier analysis showed that the survival of the high-score group was significantly lower than that of the low-score group(P<0.001).Multivariate Cox proportional hazards regression showed that high MELD-Alb score was an independent risk factor for all-cause mortality in PAH patients(HR=2.096,95%CI:1.151～3.818,P=0.016).High MELD-Alb score was a good predictor of 2-year mortality in PAH patients(C-index=0.707).The combination of elevated N-terminal pro-brain natriuretic peptide(≥650pg/ml)and high MELD-Alb score was a better predictor of 2-year mortality in PAH patients(C-index=0.749).Calibration curves exhibited good agreement between observed and predicted survival.Decision curves indicated clinical utility.The results were confirmed in the test-cohort.Conclusions:MELD-Alb scores can be used to predict the risk of all-cause mortality in PAH patients. |
PDF Full Text Request