Risk prediction in pulmonary arterial hypertension (PAH) was more accurate when combining the updated, abridged version of the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL Lite 2.0) with echocardiographic parameters, a new study found.

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According to the authors of the study, “These findings clearly show the advantage of adding echocardiography to a routine risk assessment scoring system and comprehensive echocardiography must be performed routinely with the risk assessment.”

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The highest area under the curve (AUC, 0.87) was registered for the combination of the REVEAL Lite 2.0 with the left ventricular end diastolic (LVED) eccentricity index (as a continuous variable). In addition, the combination of the REVEAL Lite 2.0 with the LVED eccentricity index (as a categorical variable, cut-off value of ≥1.2) was shown to be a better predictive model (P =.042; AUC, 0.85) than the REVEAL Lite 2.0 alone.

The combination of the REVEAL Lite 2.0 with the left ventricular end systolic (LVES) eccentricity index did not add value when compared to the REVEAL Lite 2.0 alone.

The study, recently published in Pulmonary Circulation, enrolled 134 patients with PAH from the Houston Methodist Hospital PAH clinic in Texas. The REVEAL Lite 2.0 scores of the patients indicated low-risk disease, which further validates the prognostic value of the scoring system in a low- to intermediate-risk patient population.

However, the authors recognized some limitations to the study, including missing data. They stated, “Although we used consecutive patients from our clinic, we did exclude those who were already declining at the beginning of the study duration, and this may have contributed to possible selection bias and smaller event cohort.”


Sahay S, Bhatt J, Beshay S, et al. E‐REVEAL Lite 2.0 scoring for early prediction of disease progression in pulmonary arterial hypertension. Pulm Circ. Published online December 18, 2021. doi:10.1002/pul2.12026