June 19, 2026Journal of the American College of Cardiology
Threshold of Pulmonary Hypertension Associated With Increased Mortality
Key result
eRVSP >30 mm Hg linked to ~41% higher mortality versus the lowest quintile.
- HR 1.410
- 95% CI 1.310-1.517
- P<0.001
- n=157,842
Why the study?
Current thresholds for diagnosing pulmonary hypertension may underestimate its prognostic impact.
Does an estimated right ventricular systolic pressure (eRVSP) >30.0 mm Hg increase mortality in a general echocardiography cohort?
Key Points
- This study aims to identify the prognostic impact of increasing pulmonary pressures on mortality.
- Examination of estimated right ventricular systolic pressure (eRVSP) using a cohort of 313,492 individuals.
- Data linkage to long-term survival metrics with a median follow-up of 4.2 years.
- Adjustment for age, sex, and left heart disease in mortality analyses.
- Individuals with severe PHT (eRVSP ≥60 mm Hg) had a hazard ratio of 9.73 for increased mortality (p < 0.001).
- Higher mortality rates were observed in eRVSP levels within the third (HR: 1.410) and fourth (HR: 1.979) quintiles compared to the lowest quintile.
- A significant threshold for increased mortality risk was identified around an eRVSP of 30.0 mm Hg.
Study Design
Type
Cohort (n=157,842)
Multicenter
Yes
Structured PICO
Does an estimated right ventricular systolic pressure (eRVSP) >30.0 mm Hg increase mortality in a general echocardiography cohort?
P
Population
157,842 men and women with estimated right ventricular systolic pressure data, followed for a median of 4.2 years to assess mortality.
E
Exposure
Estimated right ventricular systolic pressure (eRVSP) >30.0 mm Hg
C
Comparator
Lowest quintile of eRVSP
O
Outcome
Long-term mortality during median follow-up of 4.2 yearshard clinical
Main Result
Hazard Ratio: 1.41 (95% CI 1.31–1.517)
p-value: p=<0.001
An eRVSP >30.0 mm Hg is identified as a distinctly lower threshold for increased mortality risk indicative of pulmonary hypertension compared to currently accepted levels.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Our unique findings suggest that those currently considered to be at intermediate risk for underlying PH have a significant risk for mortality once they reach the threshold of eRVSP [higher than] 30.0 mm Hg. Future studies should characterize patients with borderline PH on the basis of eRVSP to determine the mechanisms of excess mortality, and evaluate the efficacy of therapeutic interventions to prolong survival.”
DDDr. David S. Selby
“In a large cohort of patients referred for echocardiography, an estimated right ventricular systolic pressure > 30 mmHg was associated with higher mortality rates. Although the authors demonstrated that an eRVSP > 30 mmHg is associated with higher mortality rates, it is unclear whether the elevated pulmonary pressure contributes to this, or if it is a marker of comorbidities.”
Implication
eRVSP >30 mm Hg may signal higher mortality in echo cohorts; leaves open whether to revise pulmonary hypertension thresholds pending prospective trials.
Abstract
BACKGROUND There is increasing evidence that current thresholds for diagnosing pulmonary hypertension (PHT) underestimate the prognostic impact of PHT. OBJECTIVES The aim of this study was to determine the prognostic impact of increasing pulmonary pressures within the National Echocardiography Database of Australia cohort (n = 313,492). METHODS The distribution of estimated right ventricular systolic pressure (eRVSP) was examined in 157,842 men and women. All had data linkage to long-term survival during median follow-up of 4.2 years (interquartile range: 2.2 to 7.5 years). RESULTS The cohort comprised 74,405 men and 83,437 women 65.6 ± 17.7 years of age. Overall, 17,955 (11.4%), 7,016 (4.4%), and 4,515 (2.9%) subjects had eRVSP levels indicative of mild (40 to 49 mm Hg), moderate (50 to 59 mm Hg), or severe (≥60 mm Hg) PHT, respectively, assuming a right atrial pressure of 5 mm Hg. These subjects were more likely to die during long-term follow up (for severe PHT, adjusted hazard ratio: 9.73; 95% confidence interval: 8.60 to 11.0; p < 0.001). After adjustment for age, sex, and evidence of left heart disease, those subjects with eRVSP levels within the third (28.05 to 32.0 mm Hg; hazard ratio: 1.410; 95% confidence interval: 1.310 to 1.517) and fourth (32.05 to 38.83 mm Hg; hazard ratio: 1.979; 95% confidence interval: 1.853 to 2.114) quintiles had significantly higher mortality (p < 0.001) than those in the lowest quintile. Accordingly, a clear and consistent threshold of increased mortality (including 1- and 5-year actuarial mortality) around an eRVSP of 30.0 mm Hg was evident. CONCLUSIONS In this large and unique cohort, the prognostic impact of clinically accepted levels of PHT was confirmed. Moreover, a distinctly lower threshold for increased risk for mortality (eRVSP >30.0 mm Hg) indicative of PHT was identified. (A Longitudinal Cohort Study of Echocardiograms From Public and Private Echocardiography Laboratories From Around Australia, Linked With the National Deaths Index; ACTRN12617001387314).
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
Strange et al. (2019) conducted a cohort in Pulmonary hypertension (n=157,842). Estimated right ventricular systolic pressure (eRVSP) >30.0 mm Hg vs. Lowest quintile of eRVSP was evaluated on Mortality (HR 1.410, 95% CI 1.310-1.517, p=<0.001). An estimated right ventricular systolic pressure >30.0 mm Hg was associated with significantly increased mortality compared to the lowest quintile (HR 1.410; 95% CI 1.310-1.517; p<0.001).