Relationships Among the EmPHasis-10 Questionnaire, the Simplified Four-Strata Risk Assessment Tool, and Echocardiographic Parameters in Patients with Precapillary Pulmonary Hypertension

Abstract

Background/Objectives: Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are complex diseases that require precise diagnosis and management. The ESC risk score has been used in both conditions. We assessed the relationship between the EmPHasis-10 questionnaire (patient subjective evaluation) and objective assessment using endorsed tools (simplified four-strata risk assessment and right ventricular imaging by transthoracic echocardiography). Methods: The present study retrospectively extracted data from 40 adult patients (27 PAH and 13 CTEPH cases) diagnosed in a single center in Romania. The EmPHasis-10 questionnaire and the four-strata risk assessment (FSRA) tool were applied to each patient. Mean pulmonary artery pressure (mPAP), tricuspid annular plane systolic excursion (TAPSE), TAPSE/systolic pulmonary artery pressure (TAPSE/sPAP) ratio, and right ventricular outflow tract acceleration time (RVOT-AT) were assessed. Results: A significant correlation was observed between the EmPHasis-10 scores and the FSRA tool, the WHO functional class, and the 6 min walking distance. Emphasis-10 score did not correlate with any of the echocardiographic parameters. The FSRA tool showed a moderate positive correlation with mPAP (r = 0.42, p = 0.01) and a negative correlation with TAPSE (r = -0.46, p = 0.003); additionally, across the entire cohort, it was moderately negatively correlated with both RVOT-AT (r = -0.42, p = 0.01) and TAPSE/sPAP ratio (r = -0.43, p = 0.005). Conclusions: Our study evidenced the alignment between EmPHasis-10 scores and prognostic risk score, with poorer health-related quality of life corresponding to higher FSRA. The EmPHasis-10 questionnaire proves to be a valuable, easy-to-use instrument, offering meaningful insights into patients' health-related quality of life, underscoring its utility in enhancing comprehensive patient assessment and management.

Keywords: EmPHasis-10 questionnaire; cardiac ultrasound; four-strata risk assessment; patient perspective; pulmonary hypertension; risk stratification.

Figure 1

The weighted average score for PAH group and CTEPH group.

Figure 2

EmPHasis-10 score (A) and FSRA tool (B) distribution according to WHO-FC subgroups, framed on PAH patients, CTEPH patients, and the entire cohort.

Figure 3

Linear regression performed for the entire cohort between the WHO-FC and the EmPHasis-10 questionnaire score (A) and the 6MWD and the EmPHasis-10 questionnaire score, respectively (B).

Figure 4

Pearson’s correlation for the entire cohort between the EmPHasis-10 questionnaire and the FSRA tool.

Figure 5

The key findings from the current study are illustrated for the entire cohort (A), as well as for the patients with PAH and for the CTEPH patients (B). FSRA, four-strata risk assessment tool; mPAP, mean pulmonary artery pressure; RVOT-AT, right ventricular outflow tract acceleration time; sPAP, systolic pulmonary arterial pressure; TAPSE, tricuspid annular plane systolic excursion.