Risk assessment in pulmonary hypertension

Stubbs, Harrison Douglas (2024) Risk assessment in pulmonary hypertension. MD thesis, University of Glasgow.

Abstract

Pulmonary hypertension (PH) is a disease of the pulmonary circulation that, if untreated, can progress to right ventricular failure and death. Assessment of the risk of mortality guides treatment strategies, such as the selection and modification of targeted pulmonary vasodilator therapy and consideration of lung transplantation. Risk stratification models employ multi-modality metrics which include an assessment of patient’s functional disability, exercise capacity and right ventricular impairment.

Currently used models in clinical practice require face-to-face assessment to allow objective risk stratification. In addition, risk stratification is required at regular intervals which consequently results in frequent outpatient appointments. There has been increased interest in telehealth within PH, which was further accelerated by the 2019 coronavirus pandemic, however robust methods to acquire virtual risk metrics are lacking. The first work package in this thesis aimed to describe the current challenges to the implementation of the remote assessment of risk in PH and to develop exploratory knowledge into how exercise capacity and the measurement of biomarkers could be remotely obtained. The results demonstrate that remote risk assessment in PH is feasible, although there were important caveats to the validity of such testing.

The second work package focused on the refinement of risk assessment models in PH. The first study herein demonstrates the validity of the novel 4-strata risk assessment model in a cohort of patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH). The 4-strata model is limited by the inclusion of the World Health Organisation Functional Class and the MRC Dyspnoea Scale was studied an alternative as a measure of functional limitation, with results suggesting that incorporating this may allow further refinement of risk strata. Finally, two pre-test probability algorithms (the H2FPEF and OPTICS scores) were validated to assess whether patients with pre- and post-capillary PH can be differentiated non-invasively, without the need for invasive haemodynamic studies. The results demonstrated that these non-invasive scoring systems do not have sufficient specificity to recommend their routine clinical use.

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Subjects: R Medicine > R Medicine (General); R Medicine > RC Internal medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care
• Supervisor's Name: Bhautesh, Dr. Jani and Johnston, Dr. Martin
• Date of Award: 2024
• Depositing User: Theses Team
• Unique ID: glathesis:2024-84813
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 16 Jan 2025 08:43
• Last Modified: 16 Jan 2025 08:47
• Thesis DOI: 10.5525/gla.thesis.84813
• URI: https://theses.gla.ac.uk/id/eprint/84813

Related URLs

• Article DOI
• Conference item
• Article DOI
• Article DOI
• Conference item
• Article DOI
• Conference item
• Article DOI
• Article DOI
• Conference item
• Article DOI
• Article DOI
• Article DOI
• Article DOI
• Article DOI
• Article DOI
• Conference item
• Conference item