title: Right atrial pressure/pulmonary artery wedge pressure ratio: A more specific predictor of survival in pulmonary arterial hypertension.
abstract: Pulmonary arterial hypertension (PAH) is a progressive, fatal disease. Current prognostic models are not ideal, and identifying more accurate prognostic variables is needed. The objective of this study was to evaluate the relative prognostic value of the right atrial pressure/pulmonary artery wedge pressure (RAP/PAWP) ratio in PAH patients. We hypothesized that the RAP/PAWP ratio is more predictive of survival than any of the other measured or calculated hemodynamic variables.
  
  
  
  We performed a secondary analysis of a PAH cohort (Cohort 1) and validated our results in a separate cohort (Cohort 2). Cohort 1 included primarily patients enrolled in prospective, short-term, randomized clinical trials and subsequently followed long term. Cohort 2 included patients prospectively enrolled in a PAH registry at a tertiary PAH referral center.
  
  
  
  Cohort 1 (n = 847) and Cohort 2 (n = 697) had a mean age of 47 and 54 years, respectively. Most were female (78% and 73%, respectively), Caucasian (83% and 82%), with advanced functional class disease status (New York Heart Association Functional Class III/IV 85% and 68%) and with significantly elevated hemodynamics (mean RAP/PAWP ratio: 1.2 and 1.0; pulmonary vascular resistance: 13.5 and 9.4 Wood units). RAP/PAWP ratio indicated a 1-year hazard ratio of 1.44 (p = 0.0001) and 1.35, respectively (p < 0.0001), and was the most consistently predictive hemodynamic variable across the 2 cohorts. These results remain valid even when adjusted for other covariables in multivariable regression models.
  
  
  
  The RAP/PAWP ratio is a more specific predictor of survival than any other hemodynamic variable, and we recommend that it be used in clinical prognostication and PAH predictive models.
authors: Department of Internal Medicine, Section of Pulmonary, Critical Care, & Sleep Medicine, Yale University, New Haven, Connecticut. Electronic address: wassim.fares@yale.edu.
authors: Wassim H
authors: WH
authors: Fares
authors: Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut.
authors: Lavanya
authors: L
authors: Bellumkonda
authors: Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Adriano R
authors: AR
authors: Tonelli
authors: Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina.
authors: Shannon S
authors: SS
authors: Carson
authors: Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors: Paul M
authors: PM
authors: Hassoun
authors: Department of Internal Medicine, Section of Pulmonary, Critical Care, & Sleep Medicine, Yale University, New Haven, Connecticut.
authors: Terence K
authors: TK
authors: Trow
authors: Department of Internal Medicine, Section of Pulmonary, Critical Care, & Sleep Medicine, Yale University, New Haven, Connecticut.
authors: Erica L
authors: EL
authors: Herzog
authors: Department of Internal Medicine, Section of Pulmonary, Critical Care, & Sleep Medicine, Yale University, New Haven, Connecticut.
authors: Naftali
authors: N
authors: Kaminski
authors: Department of Internal Medicine, Section of Pulmonary, Critical Care, & Sleep Medicine, Yale University, New Haven, Connecticut.
authors: Cyrus A
authors: CA
authors: Kholdani
authors: United Therapeutics Corporation, Raleigh, North Carolina.
authors: Lixia
authors: L
authors: Zhang
authors: United Therapeutics Corporation, Raleigh, North Carolina.
authors: Yi
authors: Y
authors: Zhou
authors: Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Jeffrey P
authors: JP
authors: Hammel
authors: Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.
authors: Raed A
authors: RA
authors: Dweik
mesh_terms: D062185:Atrial Pressure; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure
keywords: heart failure; hemodynamics; pulmonary heart disease; pulmonary hypertension; survival