Threshold values of individual variables within the composite echocardiographic score, and the final score based upon area under the curve (AUC) analysis

RV systolic pressure mmHg  
 ≤35 or NA0010
Right atrial area cm2    
 ≤20 or NA0010
Early diastolic pulmonary regurgitation velocity mmHg    
 <20 or NA0010
RV fractional area change %    
RV/LV short axis dimension    
 ≤1 or NA0000
Systolic eccentricity index    
 <1.1 or NA0010
Total permutations n  900 000 
Maximum score   25

Each component of the composite score was selected as that having the highest AUC to predict pulmonary hypertension using receiver operating curve analysis (figure 1 and online supplementary material) and consensus. For example, for right ventricular systolic pressure (RVSP), a minimum score of 4 and a maximum of 8 was set; this was done for each threshold and variable, thereby creating a stepwise score. Different combinations of score components (n=900 000) were then tested, and the model with the best AUC chosen, which is displayed as the best score. The order of analysis using the echo composite score is shown in the third column. For example, if a score of 7 was achieved at the first step (if RVSP >64 mmHg), then the echo score became positive to predict severe PH, and no further analysis was needed. If the RVSP was <64 mmHg, the second factor, right atrial area, was considered, and so on. RV: right ventricular; NA: not available; LV: left ventricular.