AUTHOR=Gong Su-Gang , Wu Wen-Hui , Li Chao , Zhao Qin-Hua , Jiang Rong , Luo Ci-Jun , Qiu Hong-Ling , Liu Jin-Ming , Wang Lan , Zhang Rui 

TITLE=Validity of the ESC Risk Assessment in Idiopathic Pulmonary Arterial Hypertension in China

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.745578

DOI=10.3389/fcvm.2021.745578

ISSN=2297-055X

ABSTRACT=Background: The 2015 European pulmonary hypertension guidelines recommend a risk stratification strategy for pulmonary arterial hypertension (PAH). We aimed to investigate the validation and potential prognostic information in Chinese patients. 
Methods: The risk assessment variables proposed by the PH guidelines was performed, using World Health Organization function class, 6-min walking distance, brain natriuretic peptide or its N-terminal fragment, right arterial pressure, cardiac index, mixed venous saturation, right atrium area, pericardial effusion, peak oxygen consumption and ventilatory equivalents for carbon dioxide. An abbreviated version also was applied. 
Results: The 392 patients with idiopathic PAH (IPAH) were enrolled between 2009 and 2018. After a median interval of 13 months, re-evaluation assessments were available for 386 subjects. The PAH guidelines risk tool may effectively discriminate three risk group and mortality (p< 0.001) both at baseline and re-evaluation. Meanwhile, its simplified risk version was valid for baseline and accurately predicted the risk of death in all risk group (p< 0.001). At the time of re-evaluation, the percentage of low risk group has an increase, but a greater proportion achieved high risk group and a lesser proportion maintained in intermediate risk group. 
Conclusions: The 2015 European PH guidelines and its simplified version risk stratification assessment present effective discrimination of different risk groups and accurate mortality estimates in Chinese patients with IPAH. Changes of risk proportion at re-evaluation implicated that natural treatment decisions may not be consistently with goal-oriented treatment strategy.