Heart measurements may help predict long-term PH mortality risk

Measurements that look at the interplay between the pulmonary arteries and the heart may help predict the likelihood of survival among people with all forms of pulmonary hypertension (PH), according to a study.

These measurements were able to predict mortality risk even in mild PH, whereas conventional disease severity measures are not able to predict survival odds. Based on their findings, the researchers called for further studies to determine whether integrating these measures into clinical care could improve treatment decisions and outcomes for PH patients.

The study, “Predictive Power of Pulmonary Artery Stiffness – Right Ventricular Interplay, but not Pulmonary Vascular Resistance, in Mild Pulmonary Hypertension: A PVRI GoDeep meta-registry analysis,” was published in Chest. The work was funded by the National Institutes of Health (NIH) and the Pulmonary Vascular Research Institute (PVRI).

PH is defined by abnormally high pressure in the pulmonary arteries, the vessels that carry blood from the heart through the lungs. High pressure in the pulmonary arteries puts strain on the right ventricle,  the part of the heart that pumps blood to the lungs.

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Common measures don’t capture everything

In order to assess the severity of PH, researchers and clinicians usually rely on two main measurements: mPAP (mean pulmonary artery pressure), which assesses the blood pressure inside the pulmonary arteries, and PVR (pulmonary vascular resistance), which measures how difficult it is for blood to move through the pulmonary arteries.

Although mPAP and PVR can be useful in evaluating PH, these measures don’t fully capture disease activity. The two measures may not account for how PH can cause the pulmonary arteries and right ventricle to fall out of sync, resulting in less efficient blood flow.

The researchers wanted to evaluate the utility of three other measures that may better reflect these aspects of PH: PAC (pulmonary artery compliance), Ea (arterial elastance), and SVI (stroke volume index). PAC and Ea are measures of how well the pulmonary arteries move in sync with the right ventricle, while SVI measures the volume of blood pumped by a ventricle for every heart contraction, adjusted for a person’s body surface area.

Using data from a global PH registry, PVRI GoDeep (NCT05329714), the international team of researchers conducted statistical analyses looking for associations between death risk and PAC, Ea, and SVI in people with PH. The analyses included data from nearly 17,000 people with various forms of PH.

Results showed that a lower PAC or higher Ea was significantly associated with worse survival odds. Low SVI was also linked with worse survival outcomes. All three markers showed statistically significant associations with survival risk even after adjusting for PVR. In other words, these markers provide additional prognostic insight beyond the standard PVR.

Another analysis focused on about 1,000 patients with mild PH similarly found that high Ea and low SVI were significantly associated with death risk after adjusting for PVR. This analysis did not find statistically significant links between PAC and survival odds, though it did find a link between higher mortality and elevated heart rate.

The analysis in patients with mild disease showed that the conventional measures mPAP and PVR were not significantly predictive of mortality risk. Yet “Ea, SVI and heart rate significantly stratify mortality risk in this early disease stage,” the researchers wrote.

Collectively, the findings suggest that Ea and SVI, in particular, may be useful tools for predicting long-term risk in people with PH.

“Parameters reflecting [the interplay between the pulmonary arteries and the right ventricle], in particular Ea and SVI, possess predictive power across the full [type] and severity disease-spectrum of PH, independent of the classical hemodynamic [blood flow] discriminator PVR,” the researchers wrote.