# Identifying Clinical Markers of Right Ventricular Adaptation to Improve Survival Predictions in Pulmonary Arterial Hypertension

> **NIH NIH F32** · JOHNS HOPKINS UNIVERSITY · 2024 · $102,932

## Abstract

PROJECT SUMMARY / ABSTRACT
Pulmonary arterial hypertension (PAH) is a progressive and incurable condition, with a median survival of less
than 10 years. Right ventricle (RV) adaptation to increased pulmonary artery (PA) pressures is a crucial factor in
determining disease outcomes. However, metrics of RV function remain absent from many clinical risk scores,
highlighting a need to determine the best way to measure RV function. By measuring the ratio of RV contractility
to afterload, RV-PA coupling represents a metric which can quantify the RV adaptive response. RV-PA coupling
has demonstrated utility as a high-fidelity predictor of clinical outcomes but is not routinely measured in clinical
practice due to its resource-intensive nature. Thus, there is an urgent need to identify accessible metrics that
can serve as surrogates for RV-PA coupling and report on RV adaptation.
In this proposed work, we hypothesize that a set of clinically available metrics can be identified as surrogates for
RV-PA coupling and can improve survival predictions of existing clinical risk scores. We have access to data
from over 100 subjects followed for up to 10 years who underwent same-day right heart catheterization (RHC),
RV pressure-volume (PV) loop analysis, cardiac MRI (CMR), and transthoracic echocardiogram (TTE) at a single
center after referral for suspected PAH. Leveraging this unique dataset, our proposed research aims to 1)
identify a set of clinically available metrics using a multivariable model which can act as surrogates for
RV-PA coupling and indicators of RV adaptation. We will 2) evaluate the association between the metrics
from this model and transplant-free survival in our single-center cohort. We will then 3) externally validate
survival predictions in a multi-center cohort and determine if these metrics improve prognostic value when
added into the widely used clinical risk score, the REVEAL Lite 2.0.
In conclusion, the proposed study aims to demonstrate that clinically accessible metrics can serve as surrogates
for RV-PA coupling and indicators of RV adaptation. In identifying these metrics, this work has the potential to
improve survival predictions and our assessment of disease progression in PAH. This research will provide
valuable research skills in clinical study design, prediction model development, and longitudinal analysis. The
proposed work will serve as an exceptional opportunity for developing the fundamental skills and generating the
preliminary data for a future K-level Career Development Award.

## Key facts

- **NIH application ID:** 10998296
- **Project number:** 1F32HL176077-01
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Darin Rosen
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $102,932
- **Award type:** 1
- **Project period:** 2024-09-10 → 2026-09-09

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10998296

## Citation

> US National Institutes of Health, RePORTER application 10998296, Identifying Clinical Markers of Right Ventricular Adaptation to Improve Survival Predictions in Pulmonary Arterial Hypertension (1F32HL176077-01). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10998296. Licensed CC0.

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