Diagnostic Value of strain parameters in the evaluation of probability of PH
Finally, we evaluate the ability of strain parameters to predict the presence of PH and to categorize severity in patients with probability of PH. Compared with other echocardiographic parameters (RVFAC, TAPSE, TEI), both RV-FWS and RA-GS showed an adequate AUC to identify the presence of pulmonary hypertension and their respective severity categories. RA-GS outperformed other echocardiographic parameters to detect those patients with any degree of pulmonary hypertension (AUC: 0.691, 95% CI: 0.621-0.762), while RV-FWS outperformed in those with high probability of pulmonary hypertension (AUC: 0.886, 95% CI 0.832-0.940) (Figure 6 ). RV-FWS of -27.30%, -22.60%, and -22.10% had an optimal AUC and predictive test performance to predict presence of pulmonary hypertension, and to predict intermediate-to-high probability of pulmonary hypertension, and high pulmonary hypertension, respectively. Furthermore, our identified cut-off values for RA-GS were 26.30%, 34.36%, and 37.20% to detect the previously mentioned categories (Table 2 ). Using the previously identified cut-off values in our multivariate logistic regression models, we found a significantly increased likelihood for pulmonary hypertension categories, which were maintained after adjustment for covariates (Table 3 ).