Pulmonary arterial compliance (PAC) was found to be strongly associated with all-cause mortality and clinical worsening in patients with systemic lupus erythematosus (SLE)–associated pulmonary arterial hypertension (PAH), according to a study published in Hypertension.

In this study, 120 consecutive patients (mean age, 33.5 ± 8.5; 97.5% women) who were diagnosed with SLE-associated PAH based on right heart catheterization were enrolled between February 2012 and December 2016. Of 120 participants, 47 patients had PAC ≥1.39 mL/mm Hg, and 73 had PAC <1.39 mL/mm Hg. The study’s end point was a composite of all-cause mortality and clinical worsening.

During a median follow-up of 48.0 months (interquartile range [IQR], 40.0-60.8), 49 patients (41%) experienced the composite end point after 15.0 months (IQR, 8.5-24.0). Patients with a PAC <1.39 mL/mm Hg vs PAC ≥1.39 mL/mm Hg a 3.09-fold higher risk of experiencing end point events (95% CI, 1.54-6.20, P =.001).

Stratified right ventricular afterload was found to be the only independent predictor for the study’s end point (hazard ratio, 2.009; 95% CI, 1.390-2.904; P <.001) in a multivariable Cox regression analysis. Participants with the highest right ventricular afterload (ie, PAC <1.39 mL/mm Hg and pulmonary vascular resistance [PVR] ≥10.3 Wood Unit) had the greatest risk of experiencing the end point (P <.014).

“The combination of PAC and PVR, which reflects the right ventricular afterload more precisely than PVR alone, has great value in improving the risk stratification of patients with SLE-associated PAH,” noted the study authors. “A low PAC (PAC <1.39 mL/mm Hg) with high PVR (>10.3 Wood Unit) indicates that the patients are at a particularly high risk of poor prognosis.”

Pulmonary Arterial Compliance May Predict Mortality in SLE-Associated PAH

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