Right ventricular echocardiography improves risk prediction in pulmonary arterial hypertension registry

Right ventricular function is a major determinant of outcomes in pulmonary arterial hypertension (PAH), but its assessment is not fully incorporated into mortality risk scores. The prospective, multicentre European ULTRA RIGHT VALUE registry evaluated 401 patients with prevalent PAH enrolled between January 2022 and December 2023. Participants underwent echocardiography and risk assessment using REVEAL 2.0 and European Society of Cardiology/European Respiratory Society (ESC/ERS) scoring systems. Investigators assessed associations with low-risk status and the added predictive value of echocardiographic variables.

Adding echocardiographic measures increased the c-index for morbidity and mortality prediction from 0.73 (95% CI 0.69–0.76) to 0.78 (95% CI 0.75–0.81) for ESC/ERS scores, and from 0.74 (95% CI 0.67–0.83) to 0.79 (95% CI 0.76–0.82) for REVEAL 2.0; both improvements had P < 0.01. Right ventricular–pulmonary arterial coupling measures performed best in relation to achieving or maintaining low-risk status and had the greatest influence on discrimination in machine-learning analyses.

These findings support further evaluation of right ventricular echocardiography as an adjunct to established PAH risk assessment. However, this observational analysis does not establish that incorporating these measures into clinical decisions improves patient outcomes. The available abstract does not describe follow-up duration, event counts, endpoint definitions, or external validation, limiting assessment of clinical applicability.