Grapsa et al evaluated predictors of mortality for a patient with precapillary pulmonary hypertension. These can help to identify a patient who may benefit from more aggressive management. The authors are from Hammersmith Hospital, Imperial College London, and Massachusetts General Hospital.
Patient selection: precapillary pulmonary hypertension (including pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension)
Group 1 - Major predictors of mortality:
(1) moderate or severe tricuspid regurgitation (hazard ratio 12)
Group 2 - Other predictors of mortalit(considered high risk):
(1) right ventricular myocardial performance index (MPI, see Figure 1, >= 0.64)
(2) raised right atrial pressure (RAP) in mm Hg (>= 12 mm Hg)
(3) pericardial effusion
(4) high pulmonary vascular resistance (PVR, >= 8.5 dyne/sec per cm^(-5)
(5) low cardiac index (< 3 L per min per square meter BSA)
Group 3 - Other risk factors in PAH:
(1) dilatation of the pulmonary artery (Table 3)
A patient with one or more of the risk factors listed in Group 1 or 2 are considered high risk (page 50).
