{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:18:14Z","timestamp":1787008694177,"version":"build-2736575974"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T00:00:00Z","timestamp":1594080000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100017246","name":"Radboud Institute for Health Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100017246","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,1,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Patients with pre-capillary pulmonary hypertension (PH) show poor survival, often related to right ventricular (RV) dysfunction. In this study, we assessed the 5-year prognostic value of a novel echocardiographic measure that examines RV function through the temporal relation between RV strain (\u03f5) and area (i.e. RV \u03f5-area loop) for all-cause mortality in PH patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Echocardiographic assessments were performed in 143 PH patients (confirmed by right heart catheterization). Transthoracic echocardiography was utilized to assess RV \u03f5-area loop. Using receiver operating characteristic curve-derived cut-off values, we stratified patients in low- vs. high-risk groups for all-cause mortality. Kaplan\u2013Meier survival curves and uni-\/multivariable cox-regression models were used to assess RV \u03f5-area loop\u2019s prognostic value (independent of established predictors: age, sex, N-terminal pro B-type natriuretic peptide, 6-min walking distance). During follow-up 45 (31%) patients died, who demonstrated lower systolic slope, peak \u03f5, and late diastolic slope (all P\u2009&amp;lt;\u20090.05) at baseline. Univariate cox-regression analyses identified early systolic slope, systolic slope, peak \u03f5, early diastolic uncoupling, and early\/late diastolic slope to predict all-cause mortality (all P\u2009&amp;lt;\u20090.05), whilst peak \u03f5 possessed independent prognostic value (P\u2009&amp;lt;\u20090.05). High RV loop-score (i.e. based on number of abnormal characteristics) showed poorer survival compared to low RV loop-score (Kaplan\u2013Meier: P\u2009&amp;lt;\u20090.01). RV loop-score improved risk stratification in high-risk patients when added to established predictors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our data demonstrate the potential for RV \u03f5-area loops to independently predict all-cause mortality in patients with pre-capillary PH. The non-invasive nature and simplicity of measuring the RV \u03f5-area loop, support the potential clinical relevance of (repeated) echocardiography assessment of PH patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaa143","type":"journal-article","created":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T08:09:10Z","timestamp":1588579750000},"page":"188-195","source":"Crossref","is-referenced-by-count":20,"title":["5-Year prognostic value of the right ventricular strain-area loop in patients with pulmonary hypertension"],"prefix":"10.1093","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2422-8336","authenticated-orcid":false,"given":"Hugo G","family":"Hulshof","sequence":"first","affiliation":[{"name":"Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arie P","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Research Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10 6525 GA Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria T E","family":"Hopman","sequence":"additional","affiliation":[{"name":"Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidde","family":"Heesakkers","sequence":"additional","affiliation":[{"name":"Department of Physiology, Research Institute for Health Sciences, Radboud University Medical Center, Philips van Leijdenlaan 15, 6525 EX Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith P","family":"George","sequence":"additional","affiliation":[{"name":"Research Institute 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