Researchers reported that a risk score developed based on 4 echocardiographic parameters may further help clinicians in stratifying mortality risk in patients with pulmonary arterial hypertension (PAH). Their study was published in Chest. 

Current mortality risk assessment tools in PAH rely on parameters that rarely include echocardiographic features. For example, the European Society of Cardiology PAH guidelines incorporate only 2 echocardiography parameters — pericardial effusion and right atrial area. 

The authors of the study analyzed echocardiography data from the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) database to develop an improved risk stratification score for patients with PAH. The REVEAL database contains information from patients with PAH aged 3 months and older from 54 participating sites starting in 2006. 

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The research team analyzed the data of adults with a diagnosis of group 1 PAH who had a pulmonary arterial pressure of at least 25 mmHg and a pulmonary capillary wedge pressure of 15 mmHg or less at the time of diagnosis. Patients also must have had detailed echocardiography assessments upon enrollment and after. 

A total of 2400 individuals registered in the REVEAL database met the inclusion criteria. The researchers then identified echocardiography parameters that significantly influenced survival using a stepwise Cox regression hazards model. They estimated the hazard ratio based on predicted survival at 12 months of follow-up. 

The researchers identified 4 echocardiography parameters of significance: right ventricular enlargement, reduced right ventricular systolic function, severity of tricuspid regurgitation, and pericardial effusion. These parameters were incorporated into their newly developed risk score, which ranged from 0 (low risk) to 10 (high risk).  

“The REVEAL-ECHO risk score may further discriminate risk in patients with PAH when used as an adjunct to current risk assessment scores,” the authors of the study wrote. “Further prospective validation of the added value of the REVEAL-ECHO risk score is warranted.”


El-Kersh K, Zhao C, Elliott G, et al. Derivation of a risk score (REVEAL-ECHO) based on echocardiographic parameters of patients with pulmonary arterial hypertensionChest. 2023;S0012-3692(23)00035-1. doi:10.1016/j.chest.2022.12.045