What does this research mean for the field?

Adding a single echocardiographic or right heart catheterization parameter, such as right atrial area or change in pulmonary vascular resistance, significantly improves mortality risk prediction when combined with the ESC/ERS four-strata model in patients with pulmonary arterial hypertension. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate how adding echocardiographic and hemodynamic parameters can enhance mortality risk prediction in patients with pulmonary arterial hypertension.

July 11, 2026European Heart Journal - Quality of Care and Clinical OutcomesOpen Access

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

Q: What is the clinical evidence from this study?

Study design: Observational. Population: pulmonary arterial hypertension (n=197). Intervention: Addition of right atrial area and percentage change in pulmonary vascular resistance vs. ESC/ERS four-strata model alone. Primary outcome: all-cause mortality risk prediction (AUC) (p=0.0005).

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Key result

Adding right atrial area and change in PVR improves ESC/ERS mortality prediction in PAH.

P=0.0005
n=197

Why the study?

The ESC/ERS-recommended four-strata mortality risk stratification for prevalent pulmonary arterial hypertension patients does not incorporate echocardiographic or right heart catheterization measures.

Does adding echocardiographic or right heart catheterization parameters to the ESC/ERS four-strata model improve mortality prediction in patients with pulmonary arterial hypertension?

Key Points

This research aims to evaluate how adding echocardiographic and hemodynamic parameters can enhance mortality risk prediction in patients with pulmonary arterial hypertension.
Multicenter observational study (FOCUS-PAH) with selected patients undergoing echocardiography and right heart catheterization.
Follow-up period of 6 years to assess all-cause mortality.
Risk prediction model performance was evaluated using Cox regression and ROC curves.
Right atrial area (HR 1.09) and percentage change in pulmonary vascular resistance (HR 1.01) were independent mortality predictors.
The ESC/ERS four-strata model's AUC improved from 0.66 to 0.77 with the addition of echocardiographic parameters.
Including echocardiographic parameters reclassified 25% of patients into more appropriate risk groups.

Study Design

Type

Observational (n=197)

Multicenter

Yes

Structured PICO

Does adding echocardiographic or right heart catheterization parameters to the ESC/ERS four-strata model improve mortality prediction in patients with pulmonary arterial hypertension?

Population

197 prevalent patients with pulmonary arterial hypertension who underwent echocardiography and right heart catheterization within 12 months of diagnosis, followed for up to 6 years.

Exposure

Addition of echocardiographic (right atrial area) or right heart catheterization (percentage change in pulmonary vascular resistance or right atrial pressure) parameters to the ESC/ERS four-strata mortality risk stratification model.

Comparator

ESC/ERS four-strata mortality risk stratification model alone.

Outcome

All-cause mortality over 6 years.hard clinical

Main Result

Absolute Event Rate: 0.77% vs 0.66%

p-value: p=0.0005

Adding a single echocardiographic or hemodynamic parameter, such as right atrial area or change in pulmonary vascular resistance, significantly improves the prognostic accuracy of the ESC/ERS four-strata risk model in patients with pulmonary arterial hypertension.

Discussion

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Implication

May refine PAH risk stratification with added echo/RHC data; hypothesis-generating and requires prospective validation before practice change.

Cite This Study

Toma et al. (2026) conducted an observational in pulmonary arterial hypertension (n=197). Addition of right atrial area and percentage change in pulmonary vascular resistance vs. ESC/ERS four-strata model alone was evaluated on all-cause mortality risk prediction (AUC) (p=0.0005). Adding right atrial area and percentage change in pulmonary vascular resistance to the ESC/ERS four-strata model improved all-cause mortality risk prediction in PAH (AUC 0.77 vs 0.66, P=0.0005).

synapsesocial.com/papers/6a51df9fc18d7f28ca50087a https://doi.org/10.1093/ehjqcco/qcag111

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Implication

May refine PAH risk stratification with added echo/RHC data; hypothesis-generating and requires prospective validation before practice change.

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

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

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

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

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