Usefulness of risk assessment tools in predicting hemodynamic outcome after balloon pulmonary angioplasty: a comparative analysis

ABSTRACT

Objectives

Several parameters of widely used risk assessment tools for pulmonary arterial hypertension (PAH) have been linked to hemodynamic outcomes of balloon pulmonary angioplasty (BPA). Therefore, we aimed to determine whether these risk assessment tools could be used to predict hemodynamic outcomes following BPA.

Methods

In this retrospective study, we included 139 patients with chronic thromboembolic pulmonary hypertension who had undergone BPA at Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College (Beijing, China). We compared the accuracies of seven well-validated risk assessment tools for predicting hemodynamic outcomes following BPA. A favorable hemodynamic outcome was defined as a mean pulmonary arterial pressure < 30 mmHg at follow-up.

Results

The baseline risk profiles varied significantly among the risk assessment tools. The US Registry to Evaluate Early and Long-Term PAH Disease Management risk scales and the French risk assessment tools rated most patients as high-risk, while the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) series and laboratory examination-based risk scales categorized most patients as having intermediate-risk profile. COMPERA 2.0 (4-strata) exhibited the highest predictive power among all risk stratifications. Noninvasive risk stratification (COMPERA 2.0 [3-strata]) showed a comparable predictive ability to that of invasive risk stratification (COMPERA 1.0) (area under the curve 0.649 vs. 0.648). Moreover, incorporating diffusing capacity of the lungs for carbon monoxide and tricuspid regurgitation velocity into COMPERA 2.0 (4-strata) further enhanced its predictive power (net reclassification index 0.153, 95% confidence interval 0.009–0.298, p = 0.038). Additionally, this refined COMPERA version had a high calibration accuracy (slope 0.96).

Conclusion

Although the risk strata distribution varied among different risk assessment tools, the proportion of patients achieving favorable hemodynamics decreased with the escalation of risk stratification in most models. The well-validated risk assessment tools for PAH could also predict hemodynamic outcomes following BPA, and the refined COMPERA 2.0 model exhibited the highest predictive ability among these. Applying risk assessment tools before BPA can facilitate early identification of patients in need of closer monitoring and more intensive interventions, contributing to a better prognosis after BPA.

KEYWORDS:

• Chronic thromboembolic pulmonary hypertension
• balloon pulmonary angioplasty
• risk stratification
• hemodynamics
• predict

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. A reviewer on this manuscript has received an honorarium from IPGM for their review work. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

Zhihong Liu and Zhihui Zhao contributed to the conception of the study. Xin Li and Yi Zhang wrote the manuscript. Qing Zhao, Qixian Zeng, Tao Yang, Qi Jin, Anqi Duan, Zhihui Zhao, and Meixi Hu contributed to data collection. Zhihong Liu, Changming Xiong, Qin Luo, and Qi Jin contributed to the acquisition of funding. All authors contributed to data analysis and interpretation. All authors critically reviewed the manuscript for intellectual content and had final responsibility for the decision to submit for publication. Zhihui Zhao and Zhihong Liu are guarantors of the paper, taking responsibility for the integrity of the work as a whole, from inception to published article.

Data availability statement

The data underlying this article will be shared upon a reasonable request made to the corresponding author.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2024.2358745

Additional information

Funding

This manuscript was funded by Beijing Municipal Science and Technology Project [Grant No. Z181100001718200]; Beijing Municipal Natural Science Foundation [Grant No. 7202168]; Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences [Grant No. 2020-I2M-C&T-B-055, Grant No. 2021-I2M-C&T-B-032, Grant No. 2023-I2M-C&T-B-063]; “Double First-Class” Discipline Construction Fund of Peking Union Medical College and Chinese Academy of Medical Sciences [Grant No. 2019E-XK04-02]; the Capital’s Funds for Health Improvement and Research [Grant No. 2020-2-4033, Grant No. 2020‐4‐4035]; the Youth Fund of Zhongshan Hospital, Fudan University [Grant No. 2021-016]; the Yangfan Project of Science and Technology Commission of Shanghai Municipality [Grant No. 22YF1439500]; Young Scientist Fund of Sichuan Provincial People’s Hospital [2023QN02]; National High Level Hospital Clinical Research Funding [Grant No. 2022-GSP-GG-35] and the Artificial Intelligence and Information Technology Application Fund of Fuwai Hospital, Chinese Academy of Medical Sciences [Grant No. 2022-AI01]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.