Pulmonary Vascular Disease: Pulmonary Hypertension |

A Simple Echocardiographic Scoring System for the Prediction of Mortality in PAH (PAH-SEAS) FREE TO VIEW

Ali Alsaad, MD; Christopher Austin, MD; Charles Burger, MD; Joseph Blackshear, MD; Carl Ruthman, MD; Robert Safford, MD; Brian Shapiro, MD
Author and Funding Information

Mayo Clinic, Jacksonville, FL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1161A. doi:10.1016/j.chest.2016.08.1270
Text Size: A A A
Published online

SESSION TITLE: Pulmonary Hypertension

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 24, 2016 at 04:30 PM - 05:30 PM

PURPOSE: Echocardiography is the most common imaging modality for assessment of the right ventricle (RV) in patients with pulmonary arterial hypertension (PAH). Echocardiographic parameters have been identified as independent risk factors for mortality in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL) and other PAH cohorts. We sought to establish a simple and practical echocardiography-based scoring system that may predict mortality in PAH.

METHODS: Retrospective analysis of 175 consecutive patients with Group 1 PAH confirmed by RHC was performed. The primary outcome was freedom from death or transplant. Baseline clinical and laboratory assessment including REVEAL risk criteria were obtained via the electronic medical record. Standard 2D and Doppler echocardiography performed at baseline was reviewed. Univariate and multivariate analyses of echocardiographic parameters were performed. The Simple Echocardiographic Assessment in PAH (PAH-SEAS) score was proposed from the multivariate analysis of echocardiographic parameters. The derivation cohort was categorized by the PAH-SEAS score and freedom from death or transplant following baseline echocardiography was assessed by Kaplan-Meier analysis. Receiver-operator characteristic (ROC) analysis was performed to identify the ideal PAH-SEAS score cutoff and for comparison to the REVEAL score.

RESULTS: Estimated right atrial pressure > 15 mmHg (HR 2.39, p=0.019), tricuspid regurgitation ≥ moderate (HR 2.16, p=0.038), and presence of pericardial effusion (HR 1.80, p=0.053) were identified as independent echocardiographic predictors of mortality in PAH. Kaplan-Meier survival analysis demonstrated excellent discrimination of the cohort by PAH-SEAS category at 1 year and 3 years, respectively (p<0.001). ROC analysis identified a cutoff of 1 point as ideal (sensitivity 89%, specificity 86%). The PAH-SEAS score performed well compared to the baseline REVEAL score at 1 year with AUC 0.88 and 0.80.

CONCLUSIONS: The echocardiography-based PAH-SEAS score is a simple tool for RV assessment that predicts freedom from death or transplant in PAH.

CLINICAL IMPLICATIONS: The components of this score are easily and reproducibly acquired on routine echocardiography, enhancing its utility in clinical practice. Although there is no substitute for routine clinical evaluation, the PAH-SEAS score may offer complementary risk assessment in addition to the REVEAL score and should be prospectively validated.

DISCLOSURE: The following authors have nothing to disclose: Ali Alsaad, Christopher Austin, Charles Burger, Joseph Blackshear, Carl Ruthman, Robert Safford, Brian Shapiro

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543