Right ventricular strain enhances the REVEAL LITE score for predicting 1-Year mortality in pulmonary hypertension

Right ventricular (RV) systolic dysfunction is crucial to the prognosis of pulmonary hypertension (PH). The value of incorporating right ventricular longitudinal strain (RVLS), a sensitive parameter for evaluating RV systolic function, in risk assessment tools has not been thoroughly investigated.

This study included adult patients with PH Group I or IV who had a transthoracic echocardiogram (TTE) within a year before starting PH-specific treatment. RV strain measurements were obtained by certified sonographers using strain software (Epsilon Imaging, Ann Arbor, MI). Variables for the REVEAL LITE 2.0 risk score were extracted from electronic medical records closest to the TTE date. A modified REVEAL LITE 2.0 score was created by subtracting or adding one point based on an ROC-derived cutoff for RVLS. ROC analysis was used to assess the area under the curve (AUC) for predicting all-cause mortality at one-year.

A total of 161 patients were included. RVLS ≤ -14% was associated with lower risk of all-cause mortality at one-year compared to RVLS >-14% after adjustment for REVEAL LITE 2.0 (aHR: 0.19; 95% CI: [0.03 to 0.94]; p = 0.042). There was a significant difference in AUC between the REVEAL LITE 2.0 and modified REVEAL LITE 2.0 in predicting all-cause mortality at one-year (0.856 vs. 0.808, p = 0.037).

RVLS was an independent predictor of all-cause mortality at one year in patients with PH. Incorporating RVLS into the REVEAL Lite 2.0 risk score may enhance its ability to predict all-cause mortality at one-year.