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      Repeatability and sensitivity to change of non-invasive end points in PAH: the RESPIRE study

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          Abstract

          End points that are repeatable and sensitive to change are important in pulmonary arterial hypertension (PAH) for clinical practice and trials of new therapies. In 42 patients with PAH, test–retest repeatability was assessed using the intraclass correlation coefficient and treatment effect size using Cohen’s d statistic. Intraclass correlation coefficients demonstrated excellent repeatability for MRI, 6 min walk test and log to base 10 N-terminal pro-brain natriuretic peptide (log 10NT-proBNP). The treatment effect size for MRI-derived right ventricular ejection fraction was large (Cohen’s d 0.81), whereas the effect size for the 6 min walk test (Cohen’s d 0.22) and log 10NT-proBNP (Cohen’s d 0.20) were fair. This study supports further evaluation of MRI as a non-invasive end point for clinical assessment and PAH therapy trials.

          Trial registration number NCT03841344.

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          Most cited references10

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          Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs

          Effect sizes are the most important outcome of empirical studies. Most articles on effect sizes highlight their importance to communicate the practical significance of results. For scientists themselves, effect sizes are most useful because they facilitate cumulative science. Effect sizes can be used to determine the sample size for follow-up studies, or examining effects across studies. This article aims to provide a practical primer on how to calculate and report effect sizes for t-tests and ANOVA's such that effect sizes can be used in a-priori power analyses and meta-analyses. Whereas many articles about effect sizes focus on between-subjects designs and address within-subjects designs only briefly, I provide a detailed overview of the similarities and differences between within- and between-subjects designs. I suggest that some research questions in experimental psychology examine inherently intra-individual effects, which makes effect sizes that incorporate the correlation between measures the best summary of the results. Finally, a supplementary spreadsheet is provided to make it as easy as possible for researchers to incorporate effect size calculations into their workflow.
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            2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).

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              Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy.

              The purpose of this study was to examine the relationship between changes in pulmonary vascular resistance (PVR) and right ventricular ejection fraction (RVEF) and survival in patients with pulmonary arterial hypertension (PAH) under PAH-targeted therapies. Despite the fact that medical therapies reduce PVR, the prognosis of patients with PAH is still poor. The primary cause of death is right ventricular (RV) failure. One possible explanation for this apparent paradox is the fact that a reduction in PVR is not automatically followed by an improvement in RV function. A cohort of 110 patients with incident PAH underwent baseline right heart catheterization, cardiac magnetic resonance imaging, and 6-min walk testing. These measurements were repeated in 76 patients after 12 months of therapy. Two patients underwent lung transplantation, 13 patients died during the first year, and 17 patients died in the subsequent follow-up of 47 months. Baseline RVEF (hazard ratio [HR]: 0.938; p = 0.001) and PVR (HR: 1.001; p = 0.031) were predictors of mortality. During the first 12 months, changes in PVR were moderately correlated with changes in RVEF (R = 0.330; p = 0.005). Changes in RVEF (HR: 0.929; p = 0.014) were associated with survival, but changes in PVR (HR: 1.000; p = 0.820) were not. In 68% of patients, PVR decreased after medical therapy. Twenty-five percent of those patients with decreased PVR showed a deterioration of RV function and had a poor prognosis. After PAH-targeted therapy, RV function can deteriorate despite a reduction in PVR. Loss of RV function is associated with a poor outcome, irrespective of any changes in PVR. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Thorax
                Thorax
                thoraxjnl
                thorax
                Thorax
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0040-6376
                1468-3296
                October 2021
                25 February 2021
                : 76
                : 10
                : 1032-1035
                Affiliations
                [1 ]departmentDepartment of Infection, Immunity and Cardiovascular Disease , The University of Sheffield , Sheffield, UK
                [2 ]departmentResearch and Development , GlaxoSmithKline , Stevenage, Hertfordshire, UK
                [3 ]departmentSheffield Pulmonary Vascular Disease Unit , Royal Hallamshire Hospital , Sheffield, UK
                [4 ]departmentDepartment of Respiratory Medicine , Bedford Hospital , Bedford, UK
                Author notes
                [Correspondence to ] Dr Andrew J Swift, Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2JF, UK; a.j.swift@ 123456sheffield.ac.uk
                Author information
                http://orcid.org/0000-0003-3724-0430
                Article
                thoraxjnl-2020-216078
                10.1136/thoraxjnl-2020-216078
                8461450
                33632769
                9684be06-63eb-4e2c-b50b-611a14d0a819
                © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/.

                History
                : 24 August 2020
                : 20 January 2021
                : 08 February 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 205188/Z/16/Z
                Award ID: 206632/Z/17/Z
                Funded by: FundRef http://dx.doi.org/10.13039/100004330, GlaxoSmithKline;
                Award ID: BIDS3000032592
                Award ID: COL100041816
                Categories
                Brief Communication
                1506
                2313
                Custom metadata
                unlocked

                Surgery
                primary pulmonary hypertension,imaging/ct mri etc
                Surgery
                primary pulmonary hypertension, imaging/ct mri etc

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