Evidence map›Paper›PMID 25981508›Full record

ArticleJACC. Cardiovascular imaging2015

Right Heart Score for Predicting Outcome in Idiopathic, Familial, or Drug- and Toxin-Associated Pulmonary Arterial Hypertension.

François Haddad, Onno A Spruijt, Andre Y Denault, Olaf Mercier, Nathan Brunner, David Furman, Elie Fadel, Harm J Bogaard, Ingela Schnittger, Bojan Vrtovec and 4 more

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In one paragraph

Article in JACC. Cardiovascular imaging, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 3 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors.

François HaddadDivision of Cardiovascular Medicine, Stanford University and Stanford Cardiovascular Institute, Palo Alto, California. Electronic address: fhaddad@stanford.edu.
Onno A SpruijtDivision of Pulmonary Medicine, VU University Medical Center, Amsterdam, the Netherlands.
Andre Y DenaultDepartment of Anesthesia and Division of Critical Care, Montreal Heart Institute, Montreal University, Montreal, Quebec, Canada.
Olaf MercierCardiovascular and Thoracic Research Center, Marie-Lannelongue Surgical Center, Université Paris-Sud, Paris, France.
Nathan BrunnerDivision of Pulmonary and Critical Care Medicine, Stanford University and Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, California.
David FurmanDivision of Cardiovascular Medicine, Stanford University and Stanford Cardiovascular Institute, Palo Alto, California.
Elie FadelCardiovascular and Thoracic Research Center, Marie-Lannelongue Surgical Center, Université Paris-Sud, Paris, France.
Harm J BogaardDivision of Pulmonary Medicine, VU University Medical Center, Amsterdam, the Netherlands.
Ingela SchnittgerDivision of Cardiovascular Medicine, Stanford University and Stanford Cardiovascular Institute, Palo Alto, California.
Bojan VrtovecDivision of Cardiovascular Medicine, Stanford University and Stanford Cardiovascular Institute, Palo Alto, California.
Joseph C WuDivision of Cardiovascular Medicine, Stanford University and Stanford Cardiovascular Institute, Palo Alto, California.
Vinicio de Jesus PerezDivision of Pulmonary and Critical Care Medicine, Stanford University and Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, California.
Anton Vonk-NoordegraafDivision of Pulmonary Medicine, VU University Medical Center, Amsterdam, the Netherlands.
Roham T ZamanianDivision of Pulmonary and Critical Care Medicine, Stanford University and Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, California.

Funding

The Cellular Response to Elafin in PAHP01HL108797 · NHLBI · STANFORD UNIVERSITY · PI NOLAN, GARRY P · 2011 to 2021
$19.7M
Pulmonary Hypertension Breakthrough InitiativeR24HL123767 · NHLBI · UNIVERSITY OF COLORADO DENVER · PI ALDRED, MICHEALA A, ERZURUM, SERPIL C. · 2014 to 2017
$10.1M
Airway redox biochemistry as a deteriminant of asthma phenotype during adolescen*U10HL109250 · NHLBI · UNIVERSITY OF VIRGINIA · PI ERZURUM, SERPIL C., GASTON, BENJAMIN · 2011 to 2016
$4.2M
NHLBI NIH HHS P01 HL108797NHLBI NIH HHS R24 HL123767NHLBI NIH HHS U10 HL109250
6 · The paper itself

Abstract

objectivesThis study sought to determine whether a simple score combining indexes of right ventricular (RV) function and right atrial (RA) size would offer good discrimination of outcome in patients with pulmonary arterial hypertension (PAH).

backgroundIdentifying a simple score of outcome could simplify risk stratification of patients with PAH and potentially lead to improved tailored monitoring or therapy.

methodsWe recruited patients from both Stanford University (derivation cohort) and VU University Medical Center (validation cohort). The composite endpoint for the study was death or lung transplantation. A Cox proportional hazard with bootstrap CI adjustment model was used to determine independent correlates of death or transplantation. A predictive score was developed using the beta coefficients of the multivariable models.

resultsFor the derivation cohort (n = 95), the majority of patients were female (79%), average age was 43 ± 11 years, mean pulmonary arterial pressure was 54 ± 14 mm Hg, and pulmonary vascular resistance index was 25 ± 12 Wood units × m(2). Over an average follow-up of 5 years, the composite endpoint occurred in 34 patients, including 26 deaths and 8 patients requiring lung transplant. On multivariable analysis, RV systolic dysfunction grade (hazard ratio [HR]: 3.4 per grade; 95% confidence interval [CI]: 2.0 to 7.8; p < 0.001), severe RA enlargement (HR: 3.0; 95% CI: 1.3 to 8.1; p = 0.009), and systemic blood pressure <110 mm Hg (HR: 3.3; 95% CI: 1.5 to 9.4; p < 0.001) were independently associated with outcome. A right heart (RH) score constructed on the basis of these 3 parameters compared favorably with the National Institutes of Health survival equation (0.88; 95% CI: 0.79 to 0.94 vs. 0.60; 95% CI: 0.49 to 0.71; p < 0.001) but was not statistically different than the REVEAL (Registry to Evaluate Early and Long-Term PAH Disease Management) score c-statistic of 0.80 (95% CI: 0.69 to 0.88) with p = 0.097. In the validation cohort (n = 87), the RH score remained the strongest independent correlate of outcome.

conclusionsIn patients with prevalent PAH, a simple RH score may offer good discrimination of long-term outcome.

Indexed as

RegistriesAdultBlood PressureEchocardiographyFemaleFollow-Up StudiesHumansHypertension, PulmonaryKaplan-Meier EstimateMalePrognosisRetrospective StudiesSurvival RateUnited StatesVentricular Function, Rightatrial functionheart failureoutcomepulmonary hypertensionright heart

Identifiers

PMID25981508
PMCPMC4466029

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.