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Pneumologie 2022; 76(05): 330-339
DOI: 10.1055/a-1740-3377
Originalarbeit

Risikoänderung bei Patienten mit Pulmonaler Arterieller Hypertonie unter medikamentöser Therapie – Ergebnisse aus vier deutschen Zentren

Risk Stratification in Patients with Pulmonary Arterial Hypertension under Treatment – Results of Four German Centers
Beate Stubbe
1   University Medicine Greifswald, Internal Medicine B, Pneumology, Greifswald
,
Michael Halank
2   Internal Medicine, Pneumology, University Hospital Dresden, Dresden, Germany
,
Hans-Jürgen Seyfarth
3   University Hospital Leipzig, Internal Medicine, Pneumology, Leipzig, Germany
,
Anne Obst
1   University Medicine Greifswald, Internal Medicine B, Pneumology, Greifswald
,
Susanna Desole
1   University Medicine Greifswald, Internal Medicine B, Pneumology, Greifswald
,
Christian F. Opitz
4   DRK Kliniken Berlin, Internal Medicine, Cardiology, Berlin, Germany
,
Ralf Ewert
1   University Medicine Greifswald, Internal Medicine B, Pneumology, Greifswald
› Author AffiliationsThis study was financially supported by Janssen-Cilag.
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Zusammenfassung

Die Risikobewertung für das abgeschätzte Überleben von PAH-Patienten ist eine wesentliche Grundlage für abgeleitete Therapieentscheidungen. Es existieren verschiedene Modelle für die Einschätzung des Risikos, welche jedoch weitgehend vergleichbar sind.

Es wurden 131 PAH-Patienten aus den Jahren 2016–2018 hinsichtlich des Risikos nach dem ESC-/ERS-Schema ausgewertet. Etwa 2 Drittel der Patienten (mittleres Alter 64 ± 14 Jahre) wiesen ≥ 3 Komorbiditäten bzw. kardiovaskuläre Risikofaktoren auf.

Zu Beginn der Beobachtung waren 13,8 % der Patienten als „low risk“, 76,3 % als „intermediate risk“ und 9,9 % als „high risk“ einzustufen. Zum Zeitpunkt der zweiten Kontrolle (im Mittel nach 12 ± 3 Monaten, Spanne 9–16 Monate) zeigten von den 111/131 (85 %) lebenden Patienten 20,7 % eine „low risk“-, 64,9 % eine „intermediate risk“- und 14,4 % eine „high risk“-Konstellation. Somit konnte lediglich ein geringer Anteil der Patienten durch die Therapie in eine günstigere Risiko-Kategorie überführt werden.

Die von uns beobachteten Patienten mit einem „low risk“-Profil hatten ein Überleben von 100 % über 24 Monate. Die Patienten mit einem „intermediate risk“-Profil zeigten nach 12 Monaten ein Überleben von 96 % und nach 24 Monaten ein Überleben von 82 %. Dagegen lag das Überleben der Patienten mit einer „high risk“-Konstellation nach 12 Monaten bei 89 % und nach 24 Monaten bei nur 51 %.

Trotz der aktuell verfügbaren therapeutischen Optionen konnte in unserer Analyse aus deutschen PH-Zentren nur ein kleiner Teil der PAH-Patienten während der Beobachtung in eine Niedrig-Risikogruppe mit guter Prognose überführt werden.

Abstract

Risk stratification plays an essential role in the management of patients with pulmonary arterial hypertension (PAH). According to the current European guidelines the expected 1-year risk of mortality for PAH patients can be categorized as low, intermediate, or high, based on clinical, non-invasive and hemodynamic data.

Data from 131 patients with incident PAH (age 64 ± 14) and frequent comorbidities (in 66.4 %) treated between 2016 and 2018 at 4 German PH centers were analyzed. At baseline, most patients were classified as intermediate risk (76 %), 13.8 % as high risk and only 9.9 % as low risk.

During follow-up while on treatment after 12 ± 3 months (range 9–16 months) 64.9 % were still classified as intermediate risk (76 %), 14.4 % as high risk and 20.7 % as low risk.

Survival at 12 and 24 months was 96 % and 82 % in the intermediate risk group, while only 89 % and 51 % of the high risk patients were alive at these time points. In contrast, all patients in the low risk category were alive at 24 months.

Despite the availability of various treatment options for patients with PAH even in specialized centers only a minority of patients can be stabilized in the low risk group associated with a good outcome.



Publication History

Article published online:
01 April 2022

© 2022. Thieme. All rights reserved.

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