Abstract 9681: Additional Role of Echocardiogram in Pulmonary Arterial Hypertension Risk Stratification According to Current ESC/ERS Guidelines

Introductioncurrent pulmonary arterial hypertension (PAH) patient risk stratification uses a multiparametric approach. A simplified risk table has been recently proposed and validated without including echocardiographic parameters.Hypothesisto evaluate the additional risk stratification role of echocardiogram in PAH patients.Methodsall patients with PAH referred to a single centre were included from 2003 to 2017. The simplified risk assessment considered the following criteriaWHO functional class, 6-min walking distance, right atrial (RA) pressure or brain natriuretic peptide plasma levels and cardiac index (CI) or mixed venous oxygen saturation (SvO2). For the last 2 criteria the worst parameter was chosen. Risk strata were defined asLow risk= at least 3 low risk and no high-risk criteria; High risk= at least 2 high risk criteria including CI or SvO2; Intermediate risk= definitions of low or high risk not fulfilled. Through a Cox analysis we evaluate the independent echocardiographic predictors of survival that were subsequently added to the simplified risk table to test whether they ameliorate its risk stratification.Results461 treatment-naïve patients were enrolled. Echocardiographic independent predictors of prognosis were the severity of tricuspid regurgitation [HR (95% CI)= 1.013 (1.006⋇1.021); p-value= 0.001], RA area [HR (95% CI)= 1.028 (1.012⋇1.045); p-value= 0.001] and the presence of pericardial effusion [HR (95% CI)= 1.533 (1.142⋇2.057); p-value= 0.004]. Only RA area significantly ameliorate the risk stratification power of the simplified PAH risk table (likelihood ratio chi2 increased from 63.8 to 68.1, likelihood ratio test= 0.039). Due to the significant correlation between RA area and both RA pressure (r= 0.470; p