Pulmonary vascular disease & thromboembolismCohort study
One echocardiographic or hemodynamic parameter improves mortality prediction by the European Society of Cardiology (ESC)/European Respiratory Society (ERS) four-strata model: a flexible approach to follow-up risk stratification in pulmonary arterial hypertension
- multicentre, observational study
Authors' conclusion
Adding one echocardiographic or RHC parameter interchangeably improves mortality risk prediction by the ESC/ERS four-strata model in PAH.
Study context
- Population
- Prevalent patients with pulmonary arterial hypertension (PAH) who underwent echocardiography and/or right heart catheterization (RHC) in the first 12 months after PAH diagnosis, with known vital status over the following 6 yearsprimary analysis (both echocardiography and RHC), 58% female, median age 55 years · primary analysis 197 · secondary analysis 394
- Participants
- 197 patients
- Exposure
- ESC/ERS four-strata model with added echocardiographic or RHC variables vs the four-strata model alone
Main finding
As reported in the abstract
Independent predictors of all-cause mortality added to ESC/ERS categories (multivariable) · follow-up
- Right atrial area (RAA)
- HR 1.09 per 1-cm² increase
- ΔPVR
- HR 1.01 per 1% change
Observational data: associations, not effects.
Further findings
| Outcome | HR (per 1-mmHg increase) |
|---|---|
| RA pressure instead of RAA | 1.08 |
- RA pressure instead of RAA — AUC with RA pressure vs four-strata model
- 0.73 vs. 0.66, P = 0.009
Discrimination (AUC) of four-strata model
- Four-strata model AUC
- 0.66
- With RAA
- 0.73 (P = 0.02)
- With ΔPVR
- 0.74 (P = 0.002)
- With both
- 0.77 (P = 0.0005)
Reclassification including RAA and ΔPVR
- Patients reclassified into more appropriate risk groups
- 25%
Secondary analysis: improvement of ESC/ERS risk prediction
- RAA AUC
- 0.73, P = 0.007
- ΔPVR AUC
- 0.68, P = 0.004
- 394 patients
Original publication
One echocardiographic or hemodynamic parameter improves mortality prediction by the ESC/ERS four-strata model: a flexible approach to follow-up risk stratification in pulmonary arterial hypertension. Eur Heart J Qual Care Clin Outcomes. Published 9 July 2026. doi:10.1093/ehjqcco/qcag111
Summarised from the published abstract; every number is checked against it