Mortality Risk Assessment Using the REVEAL 2.0 Score in Pulmonary Hypertension Secondary to Left Heart Disease

Area of Science:

• Cardiology
• Pulmonology
• Medical Informatics

Background:

• Pulmonary hypertension (PH) complicates left heart disease (LHD), leading to poorer outcomes.
• Accurate mortality prediction for PH with LHD (PH-LHD) is lacking.
• Existing PH risk calculators' utility in PH-LHD is uncertain.

Purpose of the Study:

• To evaluate the accuracy of the REVEAL 2.0 risk score in predicting mortality in PH-LHD patients.
• To assess the performance of risk stratification for PH-LHD using a validated tool.

Main Methods:

• Retrospective analysis of 161 PH-LHD patients from 2016-2022.
• Calculation of REVEAL 2.0 risk score and categorization into low, intermediate, and high-risk groups.
• Survival analysis using Kaplan-Meier and Cox proportional hazards models, with concordance index for performance assessment.

Main Results:

• 57% of patients were high-risk, 27% intermediate, and 15% low-risk at initial visit.
• 3-year survival rates were 70% (high-risk), 89% (intermediate), and 96% (low-risk).
• REVEAL 2.0 accurately predicted 3-year mortality in high-risk PH-LHD patients (HR 5.32, p < 0.001), but not between intermediate and low-risk groups.

Conclusions:

• The REVEAL 2.0 score effectively identifies high-risk PH-LHD patients for 3-year mortality.
• The score's ability to differentiate mortality risk between intermediate and low-risk PH-LHD patients is limited.
• Refinement of risk stratification tools may be needed for intermediate-risk PH-LHD populations.