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Publications

Journal Article Ahead of print 2 citations

PubMed: 42551834 DOI: 10.1016/j.ijcard.2026.134715

Prognostic relevance of the right ventricular fractional area change to pulmonary artery systolic pressure ratio in pulmonary arterial hypertension: Insights from the FOCUS-PAH registry.

Int J Cardiol

Authors: Pier Paolo Bocchino, Martina Pecoraro, Ilaria Pagliassotto, Davide Stolfo, Giulio Savonitto, Giovanni Santi, Matteo Pagnesi, Piero Gentile, Mauro Acquaro, Mauro Driussi, Luciana D'Angelo, Francesca Macera, Luke Howard, Matteo Toma, Davide Barbisan, Valentino Collini, Carlo Mario Lombardi, Carolina Bauleo, Matteo Rugolotto, Elena Bertarelli, Gianluca Pagnoni, Emanuele Bobbio, Sven-Erik Bartfay, Johanna Wermström, Laura Scelsi, Alberto Giannoni, Suela Vani, Massimo Imazio, Edoardo Airo, Francesca Coppi, Marco Metra, Andrea Garascia, Clara Hjalmarsson, Gianfranco Sinagra, Francesco Lo Giudice, Pietro Ameri, Gaetano Maria De Ferrari, Claudia Raineri

Affiliations

  • Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy.
  • Department of Medical Sciences, University of Turin, Turin, Italy.
  • Department of Medicine Clinical Science and Education, Södersjukhuset Karolinska Institutet, Stockholm, Sweden; Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.
  • Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy; Imperial College London, Faculty of Medicine, National Heart & Lung Institute, London, UK.
  • Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University Hospital of Trieste, Trieste, Italy.
  • Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
  • De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
  • Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • Cardiology, Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.
  • De Gasperis Cardio Center, Niguarda Hospital, Milano, Italy.
  • Imperial College London, Faculty of Medicine, National Heart & Lung Institute, London, UK; National Pulmonary Hypertension Service, Department of Cardiology, Hammersmith Hospital, Imperial College NHS Trust, London, UK.
  • Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
  • Department of Cardiology, Ca'Foncello Hospital, Treviso, Italy.
  • Cardiology and Pneumology Division, Fondazione Monasterio, Pisa, Italy; Institute of Clinical Physiology (IFC)-CNR, Pisa, Italy.
  • Cardiology Division, Azienda Ospedaliera Universitaria, Modena, Italy.
  • Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna (SSSA), Pisa, Italy; Cardiovascular Medicine Department, Fondazione Monasterio, Pisa, Italy.
  • Cardiovascular Medicine Department, Fondazione Monasterio, Pisa, Italy.
  • Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna (SSSA), Pisa, Italy.
  • Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine, University of Genova, Genova, Italy.
  • Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
  • Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital, Turin, Italy.

Abstract

BACKGROUND

In pulmonary arterial hypertension (PAH), echocardiographic ventriculoarterial coupling is traditionally assessed with the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). We aimed to validate the prognostic significance of the fractional area change (FAC)/PASP ratio in PAH.

METHODS

This study included patients diagnosed with PAH between April 2001 and November 2023 enrolled in the multicentre FOCUS-PAH registry. Only patients with both FAC and PASP data available at PAH diagnosis were considered. The primary outcome of the study was to assess the predictive value of FAC/PASP for 1-year and 5-year all-cause mortality.

RESULTS

347 patients were included. Mean age at PAH diagnosis was 56 ± 17 years; 144 (41.5%) patients were males. The median FAC/PASP ratio at diagnosis was 0.34%/mmHg [IQR 0.25 to 0.52%/mmHg]). 23 (6.6%) patients died during the first year of follow-up and 84 (24.2%) patients died within 5 years. At univariable Cox regression analyses, both low baseline FAC/PASP (i.e., lower than 0.37%/mmHg) and low TAPSE/PASP (i.e., lower than 0.18 mm/mmHg) significantly predicted 1-year all-cause mortality (HR 3.05 [95%CI 1.13-8.22], p-value 0.027, and HR 2.61 [95%CI 1.12-6.10], p-value 0.027, respectively); conversely, low FAC/PASP was associated with significantly higher all-cause mortality at 5 years (HR 1.69 [95%CI 1.08-2.65], p-value 0.023), whereas low TAPSE/PASP ratio was not (HR 1.21 [95%CI 0.77-1.91], p-value 0.405). In a clinical multivariable Cox regression model adjusting for age and World Health Organization functional class, a low FAC/PASP ratio was independently associated with a significantly increased risk of all-cause mortality, both at 1 year (HR 3.00 [95%CI 1.09-8.28], p-value = 0.034) and at 5 years (HR 1.72 [95%CI 1.09-2.72], p-value = 0.021).

CONCLUSIONS

In this multicentre, observational registry on patients with incident PAH, low baseline FAC/PASP was associated with significantly higher 1-year and 5-year all-cause mortality.

MeSH

Registries, Hypertension, Mortality, Pulmonary Artery, Arteries, Cardiology, Pulmonary Arterial Hypertension, Diagnosis