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.

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

Published in

International journal of cardiology. Volume 462. Pages 134715. Aug 04, 2026. Epub Aug 04, 2026.

Abstract

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.
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.
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).
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.

PMID:
42551834
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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