Risk score in patients with pulmonary hypertension using echocardiography
P V M Vargas Mieles, P C Costas Pablo, N S C Nicolas Silva Croome, N C Nicolas Caruso, G S Guillermina Soracio, A L Adrian LescanoAbstract
Background
Pulmonary hypertension (PH) outcomes are strongly influenced by right heart structure and function. We developed an echocardiography-based risk score to stratify patients into low, intermediate, and high-risk categories and evaluated its association with mortality and clinical events in a real-world PH database
Methods
PH groups (WHO/ESC classification variable ) were described. An echocardiographic risk score was constructed from routinely collected parameters reflecting right ventricular (RV) size and systolic function (e.g., RV dysfunction grade, RV diameter, RV dilation, TAPSE, tricuspid annular S’, TAPSE/PSAP), pulmonary pressure load (PSAP, estimated mean pulmonary artery pressure, diastolic pulmonary pressure), right-sided congestion/geometry (right atrial area, paradoxical septal motion), left-sided filling/function (diastolic dysfunction grade, E/e’, LV systolic function), and pericardial effusion. Patients were stratified by score tertiles: low (≤4), intermediate (5–10), and high (≥11). Associations with all-cause mortality and clinical events were assessed using contingency analyses and ordinal logistic models.
Results
The registry included PH groups 1–5 with the highest representation in Group 1. Patient-level mortality among those with known status was approximately 21.5%. Mortality increased stepwise across echocardiographic risk strata: 9.1% (low), 20.3% (intermediate), and 37.3% (high). Risk category was strongly associated with mortality (χ² p=3.24×10⁻⁹) and events (χ² p=2.21×10⁻¹¹). Each incremental increase in risk category was associated with higher odds of death (OR 2.37, 95% CI 1.79–3.15; p=2.31×10⁻⁹) and events (OR 2.18, 95% CI 1.74–2.73; p=1.09×10⁻¹¹).
Conclusions
An echocardiographic score integrating RV structure/function and pressure-load markers provides robust risk stratification in PH, identifying a high-risk subgroup with markedly elevated mortality and event burden. Prospective validation with complete follow-up time is warranted.For image description, please refer to the figure legend and surrounding text.