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Natural history of pulmonary hypertension (PH) is linked to right ventricle (RV) failure; in first phases of PH, coupling is preserved at the price of augmented RV wall tension (RVWT), which may represent an early sign of disease. Methods Patients with suspected PH, in absence of RV failure, underwent right heart catheterization and nearly-simultaneous echocardiography. We extrapolated RVWT from Laplace’s law as RV length × tricuspid regurgitation peak gradient (TRPG), and we correlated it with RV haemodynamic profile. Its impact on survival was tested. Results 190 patients were enrolled; RVWT correlated with invasive measure of RV telediastolic pressure, mean pulmonary artery (PA) pressure, PA compliance, transpulmonary gradient, pulmonary vascular resistance, right atrial pressure and RV stroke work index (all p &amp;lt; 0.001). At a mean follow-up of five years and three months, RVWT predicted all-cause mortality at univariate and multivariate analysis (p 0.036, p 0,023); tricuspid annular plane systolic excursion (TAPSE) (p 0.536), RV fractional area change (p 0.383), RV S’ (p 0.076) and TAPSE/TRPG (p 0.181) did not. Conclusions We identified a novel echocardiographic predictor of precocious RV impairment, able to predict all-cause mortality at a long-term follow-up. Regression: RVWT and invasive parameters Characteristics R - R2 p value mPAP 0.742 - 0.550 &amp;lt;0.001 PA pulsatory pressure 0.740 - 0.547 &amp;lt;0.001 RV differential pressure 0.794 - 0.630 &amp;lt;0.001 Mean RAP 0.326 - 0.106 &amp;lt;0.001 CI/RAP 0.209 - 0.044 0.012 RVSWI 0.326 - 0.106 &amp;lt;0.001 PA compliance 0.449 - .202 &amp;lt;0.001 PVR 0.531 - 0.282 &amp;lt;0.001 RV basal diameter 0.326 - 0.106 &amp;lt;0.001 RV medium diameter 0.403 - 0.162 &amp;lt;0.001 Right atrium area 0.204 - 0.042 0.013 RV FAC 0.382 - 0.146 &amp;lt;0.001 RV telediastolic area 0.347 - 0.120 &amp;lt;0.001 Correlation between RVWT and invasive haemodynamic parameters of RV function. mPAP, mean pulmonary artery pressure. RAP, right atrial pressure. CI, cardiac index. RVSWI, right ventricle stroke work index. PVR, pulmonary vascular resistance. RV, right ventricle. FAC, fractional area change. Abstract P1375 Figure. RVWT and invasive hemodynamic profile

P1375 Echocardiographic estimation of right ventricle wall tension: hemodynamic comparison and long term follow up