Arogundade Folawemimo, Jani Bhautesh, Church Colin, Brewis Melanie, Johnson Martin, Stubbs Harrison
Queen Elizabeth University Hospital Glasgow UK.
School of Health & Wellbeing University of Glasgow Glasgow UK.
Pulm Circ. 2023 Jul 2;13(3):e12257. doi: 10.1002/pul2.12257. eCollection 2023 Jul.
Risk stratification models in pulmonary arterial hypertension (PAH) rely on World Health Organisation Functional Class (WHO FC). A high proportion of patients are classified as WHO FC III, a heterogenous group which limits the stratification abilities of risk models. The Medical Research Council (MRC) Dyspnoea Scale may allow a more precise assessment of functional status and improve current risk models. We investigated the ability of the MRC Dyspnoea Scale to assess survival in PAH and compared performance to WHO FC and the COMPERA 2.0 models. Patients with Idiopathic, Hereditary or Drug-induced PAH who were diagnosed between 2010 and 2021 were included. The MRC Dyspnoea Scale was retrospectively applied as derived from a combination of patient notes, 6MWD tests results and WHO functional status using a purpose-designed algorithm. Survival was assessed using Kaplan-Meier analyses, log rank testing and Cox proportional hazard ratios. Model performance was compared with Harrell's C Statistic. Data from 216 patients were retrospectively analyzed. At baseline, of 120 patients classified as WHO FC III, 8% were MRC Dyspnoea Scale 2, 12% Scale 3, 71% Scale 4 and 10% Scale 5. The MRC Dyspnoea Scale performed well compared to the WHO FC and COMPERA models at follow up (respectively, C-statistic 0.74 vs. 0.69 vs. 0.75). It was possible to use the MRC Dyspnoea Scale to subdivide patients in WHO FC III into groups which had distinct survival estimates. We conclude that at follow-up, the MRC Dyspnoea Scale may be a valid tool for the assessment of risk stratification in pulmonary arterial hypertension.
肺动脉高压（PAH）的风险分层模型依赖于世界卫生组织功能分级（WHO FC）。很大一部分患者被归类为WHO FC III级，这是一个异质性群体，限制了风险模型的分层能力。医学研究委员会（MRC）呼吸困难量表可能会使对功能状态的评估更加精确，并改进当前的风险模型。我们研究了MRC呼吸困难量表评估PAH患者生存情况的能力，并将其表现与WHO FC和COMPERA 2.0模型进行比较。纳入了2010年至2021年间诊断为特发性、遗传性或药物性PAH的患者。MRC呼吸困难量表是通过使用专门设计的算法，结合患者病历、6分钟步行距离（6MWD）测试结果和WHO功能状态进行回顾性应用的。使用Kaplan-Meier分析、对数秩检验和Cox比例风险比评估生存情况。模型表现通过Harrell's C统计量进行比较。对216例患者的数据进行了回顾性分析。在基线时，120例被归类为WHO FC III级的患者中，8%为MRC呼吸困难量表2级，12%为3级，71%为4级，10%为5级。在随访中，与WHO FC和COMPERA模型相比，MRC呼吸困难量表表现良好（C统计量分别为0.74对0.69对0.75）。可以使用MRC呼吸困难量表将WHO FC III级患者细分为具有不同生存估计的组。我们得出结论，在随访中，MRC呼吸困难量表可能是评估肺动脉高压风险分层的有效工具。
