Noninvasive clinical procedures such as echocardiography can play an important role in predicting clinical outcomes in patients with pulmonary arterial hypertension (PAH), according to a study published in the ERJ Open Research. 

Over the years, clinicians have developed various models to estimate the risk of morbidity and mortality in patients with PAH. These risk models tend to include a mixture of invasive and noninvasive clinical procedures. 

Risk assessment is an important part of PAH care because it helps physicians to refine their therapeutic strategies. For example, physicians may use risk assessment tools to determine whether a lung transplantation is in a patient’s best interest. The routine assessment of exercise capacity and biochemical markers related to myocardial stress allows physicians to estimate the near- to medium-term functional status of their patients. 

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The authors of the study sought to investigate the use of noninvasive procedures during follow-up visits to predict clinical outcomes in patients with PAH. They set out to identify the noninvasive tools most useful in predicting 1-year prognosis. To carry out the study, they retrospectively accessed data from patients who were diagnosed with PAH at the University Medical Center Hamburg-Eppendorf in Germany between January 2009 and December 2019.  Disease diagnosis was achieved via interdisciplinary consensus, and follow-ups were conducted every 3 to 6 months. 

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The research team collected data on nonclinical procedures performed, such as electrocardiogram, the 6-minute walk test, pulmonary function tests, and echocardiography, among others. They also monitored the clinical status of participants during each follow-up visit. 

Two hundred ninety-eight patients with PAH were included in the study. The research team was able to produce a model combining 7 noninvasive variables that were judged to best predict future outcome events during follow-up meetings. These include the 6-minute walk test, various lung performance parameters, functional capacity, and the aspartate transaminase to alanine transaminase ratio. 

“Our systematic approach indicates that incorporation of multi-modal routinely measured noninvasive clinical variables may increase accuracy of risk models in predicting future outcome events during follow-up in patients with PAH,” the researchers concluded. 


Ostermann J, Pott J, Hennigs JK, et al. Residual risk identified in routine noninvasive follow-up assessments in pulmonary arterial hypertensionERJ Open Res. Published online May 30, 2023. doi:10.1183/23120541.00072-2023