Integrating TAPSE/PASP ratio with REVEAL Lite 2.0 improved PAH risk prediction accuracy to C-index 0.734 and AUC ROC 0.764, outperforming the baseline score alone.
Does integrating echocardiographic parameters (TAPSE/PASP or dEI) with the REVEAL Lite 2.0 score improve risk prediction for death and lung transplantation in patients with PAH?
Integrating echocardiographic parameters like TAPSE/PASP ratio with the REVEAL Lite 2.0 score significantly improves risk prediction for death and lung transplantation in patients with pulmonary arterial hypertension.
Absolute Event Rate: 0% vs 0%
Abstract Background Pulmonary arterial hypertension (PAH) is a life-threatening disease where accurate risk stratification is crucial. Although multiple prognostic scores exist, most underrepresent echocardiographic parameters, despite the key role of right ventricular function in determining prognosis. This study aims to enhance risk prediction by integrating the REVEAL Lite 2.0 score with echocardiographic parameters—specifically, the tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio or the diastolic eccentricity index (dEI)—to predict outcomes such as death and lung transplantation. Methods We analyzed 97 consecutive patients with PAH who underwent transthoracic echocardiography. Patients were stratified using the REVEAL Lite 2.0 score (1), which was modified into two models: (1) incorporating TAPSE/PASP ratio (cutoff 0.32) and (2) incorporating dEI (cutoff 1.3) as risk modifiers. The proposed models reclassified patients into four risk strata (Figure 1). Cox regression analysis was performed over a three-year follow-up to assess clinical outcomes. Discriminatory ability was evaluated using Harrell’s C-statistic, the area under the receiver operating characteristic (ROC) curve, and the Brier Score. Survival curves were generated using the Kaplan-Meier method. Results A stepwise increase in risk was observed with REVEAL Lite 2.0 (HR 6.35, p = 0.002; HR 8.02, p 0.001 for intermediate and high-risk patients, respectively). Both TAPSE/PASP ratio (HR 11.96, p = 0.017) and dEI (HR 3.26, p = 0.016) were significantly associated with the composite endpoint. The TAPSE/PASP-enhanced model reclassified 22 patients from intermediate to intermediate-high risk, with hazard ratios for new categories as follows: intermediate-low (HR 6.95, p = 0.021), intermediate-high (HR 12.76, p = 0.002), and high risk (HR 15.82, p = 0.001). Similarly, the dEI-enhanced model showed significant reclassification (HR 5.27, p = 0.047 for intermediate-low risk; HR 16.26, p = 0.001 for intermediate-high risk; HR 12.16, p = 0.003 for high risk). Both modified models improved predictive accuracy over the baseline REVEAL Lite 2.0 score, with the TAPSE/PASP-enhanced model achieving a C-index of 0.734 and AUC ROC of 0.764, and the dEI-enhanced model achieving a C-index of 0.750 and AUC ROC of 0.735. Conclusions While REVEAL Lite 2.0 alone performs well, its predictive accuracy is further strengthened by incorporating echocardiographic parameters. Among the proposed models, the combination of REVEAL Lite 2.0 with TAPSE/PASP provides the best overall performance, as evidenced by the highest C-Harrell index and AUC ROC, along with the lowest Brier Score. These findings suggest that integrating additional echocardiographic variables can significantly improve risk prediction models in PAH.Baseline characteristics Improved Models and Survival curves
Ortiz et al. (Sat,) reported a other. Integrating TAPSE/PASP ratio with REVEAL Lite 2.0 improved PAH risk prediction accuracy to C-index 0.734 and AUC ROC 0.764, outperforming the baseline score alone.
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