Correlations between longitudinal changes in right ventricle to pulmonary artery coupling and improvements in multiparametric risk scores: a single-center pulmonary hypertension cohort

Aims This study evaluated the relationship between longitudinal changes in right ventricle-to-pulmonary artery (RV-PA) coupling and improvements in multiparametric risk scores (MRSs) at baseline and during follow-up (FU) in patients with pulmonary hypertension (PH). Methods We retrospectively analyzed 1,213 patients with PH. Patients underwent periodic clinical and echocardiographic evaluations at 3 to 6-month intervals. Risk stratification was performed using ESC/ERS, COMPERA 2.0, SPAHR, REVEAL 2.0, REVEAL lite 2.0, and FPHN models. The TAPSE/PASP ratio was utilized as a surrogate for RV-PA coupling. Results During a median FU of 616 days (IQR: 135–1900), 5-year survival rates for Groups 1, 2, 3, and 4 were 56.9%, 40.6%, 27.4%, and 51.9%, respectively (p<0.001). All MRSs showed significant improvements from baseline to the first control visit (65% to 89% reduction in high-risk status). Longitudinal improvements in TAPSE, S’, and TAPSE/PASP ratio were significant, particularly in Group 1 (p<0.001). Group 4 and idiopathic PAH subgroups exhibited higher increases in the TAPSE/PASP ratio compared to Group 1 and congenital heart disease-associated PAH, respectively (p<0.001). Baseline TAPSE/PASP ratio showed moderate negative correlations with REVEAL 2.0 (r = -0.376), SPAHR (r = -0.342), and COMPERA 2.0 (r = -0.340, all p<0.001). Notably, when evaluating longitudinal changes (delta) from baseline to 12 months, the strongest correlations were identified between delta TAPSE/PASP and delta REVEAL Lite 2.0 (r = -0.357, p<0.001) and delta REVEAL 2.0 (r = -0.330, p<0.001). However, delta TAPSE/PASP did not correlate significantly with changes in other MRS models. Improvements in functional class, 6MWD, risk status across all MRSs, and RV-PA coupling at 6 and 12 months were all independently associated with reduced mortality (p=0.011 to p<0.001). Conclusion In our PH cohort, serial assessments revealed significant concordance between improvements in RV /PA coupling and changes in REVEAL lite 2.0 and REVEAL 2.0 scores from baseline with targeted therapies that can be translated to survival benefit.