{"doi":"10.3390/jcm11144034","title":"Risk Stratification of Patients with Pulmonary Arterial Hypertension: The Role of Echocardiography","abstract":"Background: Given the morbidity and mortality associated with pulmonary arterial hypertension (PAH), risk stratification approaches that guide therapeutic management have been previously employed. However, most patients remain in the intermediate-risk category despite initial therapy. Herein, we sought to determine whether echocardiographic parameters could improve the risk stratification of intermediate-risk patients. Methods: Prevalent PAH patients previously enrolled in observational studies at 3 pulmonary hypertension centers were included in this study. A validated PAH risk stratification approach was used to stratify patients into low-, intermediate-, and high-risk groups. Right ventricular echocardiographic parameters were used to further stratify intermediate-risk patients into intermediate-low- and intermediate-high-risk groups based on transplant-free survival. Results: From a total of 146 patients included in our study, 38 patients died over a median follow-up of 2.5 years. Patients with intermediate-/high-risk had worse echocardiographic parameters. Tricuspid annular plane systolic excursion (TAPSE) and the degree of tricuspid regurgitation (TR) were highly associated with survival (p < 0.01, p = 0.04, respectively) and were subsequently used to further stratify intermediate-risk patients. Among intermediate-risk patients, survival was worse for patients with TAPSE < 19 mm compared to those with TAPSE ≥ 19 mm (estimated one-year survival 74% vs. 96%, p < 0.01) and for patients with moderate/severe TR compared to those with no/trace/mild TR (estimated one-year survival 70% vs. 93%, p < 0.01). Furthermore, among intermediate-risk patients, those with both TAPSE < 19 mm and moderate/severe TR had an estimated one-year survival (56%) similar to that of high-risk patients (56%), and those with both TAPSE ≥ 19 mm and no/trace/mild TR had an estimated one-year survival (97%) similar to that of low-risk patients (95%). Conclusions: Echocardiography, a routinely performed, non-invasive imaging modality, plays a pivotal role in discriminating distinct survival phenotypes among prevalent intermediate-risk PAH patients using TAPSE and degree of TR. This can potentially help guide subsequent therapy.","journal":"Journal of Clinical Medicine","year":2022,"id":257667,"datarank":0.44166584687496613,"base_score":2.9444389791664403,"endowment":2.9444389791664403,"self_citation_contribution":0.44166584687496613,"citation_network_contribution":0.0,"self_endowment_contribution":0.44166584687496613,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":18,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9527,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":773086,"name":"Hussein J. Hassan","orcid":null,"position":1,"is_corresponding":false},{"id":307540,"name":"Mario Naranjo","orcid":"0000-0001-7584-2489","position":2,"is_corresponding":false},{"id":908164,"name":"Alessandra Cuomo","orcid":"0000-0002-5781-2865","position":3,"is_corresponding":false},{"id":430557,"name":"Jeremy A. Mazurek","orcid":"0000-0002-3332-0102","position":4,"is_corresponding":false},{"id":459796,"name":"Paul R. Forfia","orcid":"0000-0003-0547-9789","position":5,"is_corresponding":false},{"id":772445,"name":"Aparna Balasubramanian","orcid":"0000-0002-1854-6672","position":6,"is_corresponding":false},{"id":366753,"name":"Catherine E. Simpson","orcid":"0000-0002-2388-5660","position":7,"is_corresponding":false},{"id":270319,"name":"Rachel L. Damico","orcid":"0000-0002-2584-1557","position":8,"is_corresponding":false},{"id":474745,"name":"Todd M. Kolb","orcid":"0000-0003-0524-7400","position":9,"is_corresponding":false},{"id":333953,"name":"Stephen C. Mathai","orcid":"0000-0003-3188-7209","position":10,"is_corresponding":false},{"id":683565,"name":"Steven Hsu","orcid":"0000-0002-8384-2638","position":11,"is_corresponding":false},{"id":536160,"name":"Monica Mukherjee","orcid":"0000-0001-6088-0773","position":12,"is_corresponding":false},{"id":270321,"name":"Paul M. Hassoun","orcid":"0000-0003-0601-4975","position":13,"is_corresponding":false},{"id":232191,"name":"Valentina Mercurio","orcid":"0000-0002-9448-2762","position":0,"is_corresponding":true}],"reference_count":47,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T00:25:34.440699Z","pmid":"35887800","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}