{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T11:01:02Z","timestamp":1774868462828,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Henan Province Medical Science and Technology Research Program","award":["LHGJ20240772"],"award-info":[{"award-number":["LHGJ20240772"]}]},{"name":"Nanyang City Science and Technology Program","award":["24JCQY056"],"award-info":[{"award-number":["24JCQY056"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: The right ventricular free wall longitudinal strain to pulmonary arterial systolic pressure (RVFWLS\/PASP) ratio is an emerging echocardiographic index for evaluating right ventricular\u2013pulmonary artery (RV-PA) coupling. This study aimed to evaluate its prognostic significance and incremental value in risk stratification for patients with pulmonary arterial hypertension (PAH). Methods: We conducted a retrospective\u2013prospective cohort study of 149 adult PAH patients (87 idiopathic PAH and 62 connective tissue disease-associated PAH). RVFWLS was measured via speckle tracking echocardiography, and PASP was estimated using Doppler. The primary endpoint was event-free survival, defined as the first occurrence of all-cause mortality, lung transplantation, or rehospitalization for right heart failure. Kaplan\u2013Meier and multivariate Cox regression analyses were performed to identify independent predictors. Results: During a median follow-up of 32 months, 78 primary events occurred. Patients in the lower RVFWLS\/PASP group (&lt;0.246%\/mmHg) exhibited significantly worse exercise capacity, higher NT-proBNP levels, and poorer hemodynamics compared with the higher group (\u22650.246%\/mmHg) (all p &lt; 0.001). The event-free survival rate for the composite endpoint was significantly lower in the group with reduced RVFWLS\/PASP compared with that observed in the higher RVFWLS\/PASP group (log-rank p &lt; 0.05). Multivariate Cox regression analysis demonstrated RVFWLS\/PASP \u2265 0.246%\/mmHg was independently predictive of reduced risk for the primary endpoint (HR = 0.46, 95%CI 0.23\u20130.93, p &lt; 0.05). Moreover, RVFWLS\/PASP facilitated additional risk stratification among patients classified as low risk based on established models (FPHN, COMPERA 2.0, and REVEAL Lite 2). Conclusions: RVFWLS\/PASP is a robust, independent determinant of long-term prognosis in patients with PAH. As a noninvasive measure of RV-PA coupling, it provides significant incremental value for clinical risk assessment and treatment monitoring.<\/jats:p>","DOI":"10.3390\/jcdd13040151","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T09:57:11Z","timestamp":1774864631000},"page":"151","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of the RVFWLS\/PASP Ratio in Pulmonary Arterial Hypertension"],"prefix":"10.3390","volume":"13","author":[{"given":"Hongjie","family":"Bian","sequence":"first","affiliation":[{"name":"Nanyang Second General Hospital, Henan Medical University, Nanyang 473000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4309-8880","authenticated-orcid":false,"given":"Qinhua","family":"Zhao","sequence":"additional","affiliation":[{"name":"Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengling","family":"Ju","sequence":"additional","affiliation":[{"name":"Nanyang Second General Hospital, Henan Medical University, Nanyang 473000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7270-1397","authenticated-orcid":false,"given":"Lan","family":"Wang","sequence":"additional","affiliation":[{"name":"Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yupei","family":"Han","sequence":"additional","affiliation":[{"name":"Nanyang Second General Hospital, Henan Medical University, Nanyang 473000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9992-3811","authenticated-orcid":false,"given":"Hongling","family":"Qiu","sequence":"additional","affiliation":[{"name":"Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cijun","family":"Luo","sequence":"additional","affiliation":[{"name":"Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pei","family":"Gang","sequence":"additional","affiliation":[{"name":"Nanyang Second General Hospital, Henan Medical University, Nanyang 473000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke","family":"Li","sequence":"additional","affiliation":[{"name":"Nanyang Second General Hospital, Henan Medical University, Nanyang 473000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xumeng","family":"Ding","sequence":"additional","affiliation":[{"name":"Nanyang Second General Hospital, Henan Medical University, Nanyang 473000, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1093\/eurheartj\/ehl477","article-title":"Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension","volume":"28","author":"Marcus","year":"2007","journal-title":"Eur. 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