ClinicalTrials.gg
RecruitingNCT07822997EMPHASIS-10-BRUpdated Sep 16, 2026

Quality of Life Questionnaire in Pulmonary Hypertension EMPHASIS-10: Brazilian Adaptation and Validation

An observational study in Pulmonary Hypertension and Quality of Life, sponsored by Hospital de Clinicas de Porto Alegre. Recruiting at 1 site in Brazil. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-09-16.

Sponsored by Hospital de Clinicas de Porto Alegre · Observational

From the registry’s dates

  • Started Mar 2026; still recruiting 8 months later.
Study type
Observational
Model
Case-only
Time perspective
Cross-sectional
Enrollment
50
Ages
18 Years and older
Sex
All
01

Where this study stands

Counted across the records on this site · 2026-11-12

Among 42 studies in Hypertension, Pulmonary with a site in Brazil — 10 open to participants now, 13 under way, 3 of them phase 3. Hypertension, Pulmonary · Brazil.

Planned enrollment
10th of 12
50 · median 123
Started
2026
with 1 other
Observational
12 of 42
4 open now
Primary completion
2027-03
later than 9 of 12 live
Registered
42nd of 42
by date
Lead sponsor
2 of 42
Hospital de Clinicas de Porto Alegre

Among the 42 studies in Hypertension, Pulmonary with a site in Brazil, this one is the 10th largest by planned enrollment of the 12 observational ones that give a count, is one of 2 that started in 2026, is one of 12 observational ones, reaches primary completion later than 9 of the 12 other live ones, and was the 42nd registered.

Hypertension, Pulmonary

1,091 studies on the registry are indexed under Hypertension, Pulmonary; 243 are open to participants now.

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Open to participants now

10 of the 42 studies in Hypertension, Pulmonary with a site in Brazil are open now. Recruiting first, the newest first:

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A study can be open while its sites in Brazil have not opened yet or have stopped. Only those recruiting at a site in Brazil →

Who these studies take

Of the 163 Hypertension, Pulmonary studies recruiting now, 99 (61%) set no upper age limit and 26 (16%) stop at 75 or younger; 39 take children under 18; 24 take healthy volunteers.

This study: 18 Years and older · all sexes · no healthy volunteers.

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02

Study summary

Pulmonary hypertension (PH) is a severe and heterogeneous condition associated with poor prognosis and significant impairment in quality of life. Patient-reported outcome questionnaires are useful, low-cost tools for clinical assessment and risk stratification. The EmPHasis-10 questionnaire is a brief and easy-to-administer instrument that has demonstrated good correlation with clinical outcomes across different PH populations; however, a validated Brazilian Portuguese version is not yet available.

This study aims to translate, culturally adapt, and validate the EmPHasis-10 questionnaire for Brazilian patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The investigators designed a cross-sectional observational study including 50 adult patients with a confirmed diagnosis of PAH (group 1) or CTEPH (group 4), followed at the Pulmonary Circulation Outpatient Clinic of Hospital de Clínicas de Porto Alegre. The EmPHasis-10-BR will be administered alongside the SF-36 questionnaire for concurrent validity analysis, as well as frailty assessment instruments. Reliability will be evaluated through test-retest analysis in both in-person and remote settings.

Clinical, functional, and hemodynamic variables will also be collected to investigate associations between EmPHasis-10-BR scores and risk stratification parameters recommended by international guidelines. Statistical analyses will include Cronbach's alpha to assess internal consistency, Spearman's correlation coefficients for test-retest reliability, and comparisons with previously validated instruments.

The investigators expect that the validation of the EmPHasis-10-BR will provide a practical, reliable, and culturally appropriate tool for quality-of-life assessment in Brazilian patients with PH, supporting standardized clinical follow-up, risk stratification, and potentially contributing to therapeutic decision-making.

Read the detailed description

LOGISTICS AND STUDY PROCEDURES The use of the EmPHasis-10 questionnaire was authorized by the Pulmonary Hypertension Association - United Kingdom (PHA-UK), the organization holding its copyright, and the translation process will be conducted in accordance with the guidelines provided by PHA-UK.

The translation process will initially consist of two independent translations into Brazilian Portuguese performed by two independent translators. Subsequently, the questionnaire will be back-translated into English by a third independent translator. All translations will be reviewed by a committee composed of three pulmonologists specialized in pulmonary circulation, members of the research team, and fluent in both languages.

A review report of the back-translation will be submitted to PHA-UK, which may provide suggestions that will be forwarded to the investigators for further adjustments, if necessary. After the final version is established, the questionnaire will be pilot-tested in five patients. After completing the questionnaire, these patients will be asked about comprehension of each EmPHasis-10-BR item using the following questions: Was this item understood? What does this item mean? Can this item be explained in different words? Can alternative wording be suggested? A report based on this pilot study will be prepared and reviewed by pulmonary hypertension specialists to identify any additional adjustments that may be required.

After finalization, patients who meet the eligibility criteria will undergo collection of demographic data and information related to health status, comorbidities, symptoms, and complementary test results. Eligible patients will be invited to participate during outpatient clinic visits and will be referred to the Pulmonology Department after completion of the routine appointment to initiate study procedures.

At the first study visit, after signing the written informed consent form, the EmPHasis-10-BR questionnaire will be administered by a trained interviewer. Test-retest reliability will be assessed through an in-person reassessment conducted 7 to 14 days later at the Pulmonology Department. During this second visit, after administration of the EmPHasis-10-BR, participants will also complete the CAMPHOR questionnaire, the SF-36 questionnaire and the Fried Frailty Phenotype criteria.

A third contact will be conducted by telephone 7 to 14 days after Visit 2 to validate the questionnaire for remote administration.

In addition, routine clinical data used for pulmonary hypertension risk stratification will be collected through medical record review, in accordance with standard outpatient care at the Pulmonary Circulation Clinic. These data will include laboratory tests, echocardiography, six-minute walk test, cardiopulmonary exercise testing, cardiac magnetic resonance imaging, and right heart catheterization results.

All collected data will be entered into a Google Sheets® database by a single investigator.

STUDY VARIABLES Independent variables: demographic data; smoking history and smoking index; anthropometric measurements; comorbidities; medications; NYHA functional class; pulmonary hypertension etiology and group; ESC risk stratification; complementary test results.

Dependent variable: EmPHasis-10-BR score.

STATISTICAL ANALYSIS Quantitative variables will be expressed as mean ± standard deviation or median and interquartile range, according to data distribution. The Shapiro-Wilk test will be used to assess normality. Qualitative variables will be expressed as percentages, and 95% confidence intervals will be calculated when appropriate.

Internal consistency of the EmPHasis-10-BR will be evaluated using Cronbach's alpha. Values below 0.7 will be considered indicative of insufficient internal consistency. Item-total correlations are expected to range between 0.2 and 0.8.

Test-retest reliability will be assessed by correlating EmPHasis-10-BR scores obtained at different time points (Visit 1 and Visit 2), assuming no clinical change occurred between administrations. A minimum correlation coefficient of 0.85 will be required to indicate adequate reliability, using Spearman's correlation test. A similar analysis will be performed comparing in-person (Visit 2) and remote (Visit 3) administrations.

Additionally, EmPHasis-10-BR scores will be compared with general and disease-specific quality-of-life questionnaires validated in Portuguese, namely the 36-item Short Form Health Survey (SF-36) and the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR).

All statistical tests will be two-tailed, and p values \< 0.05 will be considered statistically significant. Data will be analyzed using the Statistical Package for the Social Sciences (SPSS), version 18.0 for Windows (SPSS Inc., Chicago, IL, USA).

RISKS The potential risks associated with participation in this study include unauthorized disclosure or identification of patient-related data. However, all measures to ensure confidentiality will be adopted. The investigators commit to preserving participants' privacy throughout the study and to using all collected information solely for the execution of this research project.

BENEFITS The expected benefits of this study include the validation of the EmPHasis-10 questionnaire for use in Brazilian Portuguese, aiming to standardize clinical assessment and generate reliable data for longitudinal follow-up. Additionally, the instrument may support non-invasive, low-cost risk stratification and prognostic assessment, with potential applicability across different levels of healthcare.

03

Conditions studied

  • Pulmonary Hypertension
  • Quality of Life

Keywords

  • pulmonary hypertension
  • quality of life
  • questionnaire validation
04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

The study population will consist of patients diagnosed with pulmonary hypertension from clinical groups 1 and 4, according to the classification of the most recent World Symposium on Pulmonary Hypertension, who are followed on an outpatient basis at the Pulmonary Circulation Clinic of the Pulmonology Department of Hospital de Clínicas de Porto Alegre (HCPA). Patients will be consecutively recruited during the study period. A minimum disease duration or follow-up period of 6 months will be required.

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Willingness to participate in the study after being informed and having provided written ;
  • Age ≥ 18 years;
  • Diagnosis of precapillary pulmonary hypertension from groups 1 and 4, confirmed by right heart catheterization;
  • Clinically stable patients with no changes in therapy for at least 3 months;
  • Native speaker of Brazilian Portuguese;
  • Literate patient.

Exclusion criteria

Exclusion Criteria:

  • Diagnosis of pulmonary hypertension from groups 2, 3, and/or 5;
  • Spirometry showing forced vital capacity (FVC) ≤ 70% predicted and/or (FEV₁) ≤ 60% predicted;
  • Severe communication impairment, including major cognitive deficit or severe hearing or visual impairment, resulting in inability to respond to the questionnaires or to understand the study procedures;
  • Patients who experience clinical exacerbation or worsening between the days on which the questionnaires are administered;
  • Refusal to participate in the study.
Terms in these criteria, in plain language(2)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

FEV1

From a breathing test (spirometry): how much air you can blow out in the first second. Often given as a percentage of what is expected for your age, height and sex.

05

Study design

Observational model
Case-only
Time perspective
Cross-sectional
Enrollment
50 participants (estimated)
Patient registry
No
06

What researchers measure

Primary outcomes

  1. Internal consistency of the EmPHasis-10-BR questionnaire measured by Cronbach's alpha

    EmPHasis-10 Brazilian Portuguese version (EmPHasis-10-BR): Evaluates health-related quality of life in pulmonary hypertension. Scores range from 0 to 50, where higher scores indicate a worse outcome (greater disease impact/lower quality of life).

    Time frame: 7-28 days

  2. Test-retest reliability measured by Spearman's correlation coefficient

    Time frame: 7-28 days

  3. Concurrent validity assessed by correlation with SF-36 questionnaire

    Concurrent validity considering the SF-36 (Brazilian Portuguese version), a generic questionnaire of 36 items evaluating health-related quality of life across 8 domains (Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, and Mental Health) and 2 summary component scores (PCS and MCS). Transformed scores for each domain/component range from 0 to 100, where higher scores indicate a better outcome (better overall health status and higher quality of life).

    Time frame: 7-28 days

Secondary outcomes

  1. Concurrent validity of the EmPHasis-10-BR questionnaire measured by correlation with SF-36 scores

    Concurrent validity of the EmPHasis-10 Brazilian Portuguese version (EmPHasis-10-BR) will be evaluated by assessing its correlation with the 36-Item Short Form Health Survey (SF-36) using the Spearman rank correlation coefficient. 1) EmPHasis-10-BR: A disease-specific questionnaire evaluating health-related quality of life in pulmonary hypertension. Total scores range from 0 to 50, where higher scores indicate a worse outcome (greater disease impact and lower quality of life). 2) SF-36 (Brazilian Portuguese version): A generic questionnaire of 36 items evaluating health-related quality of life across 8 domains (Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role-Emotional, and Mental Health) and 2 summary component scores (PCS and MCS). Correlation values range from -1.0 (perfect negative correlation) to +1.0 (perfect positive correlation).

    Time frame: Between enrollment to 7-28 days

  2. Correlation between age and EmPHasis-10-BR score

    Participant age, measured in years, will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis

    Time frame: Between enrollment to 7-28 days

  3. Test-retest reliability of the EmPHasis-10-BR questionnaire when administered remotely, measured by correlation coefficients

    EmPHasis-10 Brazilian Portuguese version (EmPHasis-10-BR): Evaluates health-related quality of life in pulmonary hypertension. Scores range from 0 to 50, where higher scores indicate a worse outcome (greater disease impact/lower quality of life).

    Time frame: Between enrollment to 7-28 days

  4. Correlation between EmPHasis-10-BR scores and FRAIL-BR scores

    The correlation between health-related quality of life and frailty will be assessed using the Spearman's correlation coefficient. 1) EmPHasis-10 Brazilian Portuguese version (EmPHasis-10-BR): Evaluates health-related quality of life in pulmonary hypertension. Scores range from 0 to 50, where higher scores indicate a worse outcome (greater disease impact/lower quality of life). 2) FRAIL Scale - Brazilian Portuguese version (FRAIL-BR): Assesses physical frailty based on 5 components (Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight). Total scores range from 0 to 5, where 0 = robust, 1-2 = pre-frail, and 3-5 = frail. Higher scores indicate a worse outcome (greater degree of frailty). Correlation values range from -1.0 (perfect negative correlation) to +1.0 (perfect positive correlation).

    Time frame: Between enrollment to 7-28 days

  5. Correlation between EmPHasis-10-BR scores and the Fried Frailty Phenotype Criteria scores

    The correlation between health-related quality of life and frailty will be assessed using the Spearman's correlation coefficient. 1) EmPHasis-10 Brazilian Portuguese version (EmPHasis-10-BR): Evaluates health-related quality of life in pulmonary hypertension. Scores range from 0 to 50, where higher scores indicate a worse outcome (greater disease impact/lower quality of life). 2) Fried Frailty Phenotype Criteria: Assesses physical frailty across 5 criteria (unintentional weight loss, weakness/grip strength, exhaustion, slowness/gait speed, and low physical activity). Total scores range from 0 to 5, where 0 = robust, 1-2 = pre-frail, and 3-5 = frail. Higher scores indicate a worse outcome (greater degree of frailty). Correlation values range from -1.0 (perfect negative correlation) to +1.0 (perfect positive correlation).

    Time frame: Between enrollment to 7-28 days

  6. Comparison of EmPHasis-10-BR scores across age categories

    EmPHasis-10-BR total scores will be compared across three age categories: \<50 years, 50-64 years, and ≥65 years. Age is measured in years. The Kruskal-Wallis test will be used when the distribution is non-normal, and one-way ANOVA will be used when the assumptions of normality and homoscedasticity are reasonably met.

    Time frame: 7-28 days

  7. Comparison of EmPHasis-10-BR scores by gender

    EmPHasis-10-BR total scores will be compared between male and female participants. Gender will be categorized as male or female. The Mann-Whitney U test will be used for non-normally distributed scores, and the independent-samples t-test will be used when the assumptions of normality and homoscedasticity are reasonably met.

    Time frame: 7-28 days

  8. Comparison of EmPHasis-10-BR scores by modified NYHA functional class for pulmonary hypertension

    EmPHasis-10-BR total scores will be compared between participants classified as functional class I-II and III-IV according to the modified New York Heart Association (NYHA) functional classification for pulmonary hypertension. The Mann-Whitney U test will be used for non-normally distributed scores, and the independent-samples t-test will be used when the assumptions of normality and homoscedasticity are reasonably met.

    Time frame: 7-28 days

  9. Comparison of EmPHasis-10-BR scores across ESC risk stratification categories

    EmPHasis-10-BR total scores will be compared across three pulmonary hypertension risk categories according to the European Society of Cardiology (ESC) risk stratification: low risk, intermediate risk, and high risk. The Kruskal-Wallis test will be used for non-normally distributed scores, and one-way ANOVA will be used when the assumptions of normality and homoscedasticity are reasonably met.

    Time frame: 7-28 days

  10. Comparison of EmPHasis-10-BR scores across four ESC risk stratification categories

    EmPHasis-10-BR total scores will be compared across four pulmonary hypertension risk categories according to the European Society of Cardiology (ESC) risk stratification: low risk, intermediate-low risk, intermediate-high risk, and high risk. The Kruskal-Wallis test will be used for non-normally distributed scores, and one-way ANOVA will be used when the assumptions of normality and homoscedasticity are reasonably met.

    Time frame: 7-28 days

  11. orrelation between six-minute walk test distance and EmPHasis-10-BR score

    Six-minute walk test distance, measured in meters, will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis. A multivariable linear regression model will also be performed with the EmPHasis-10-BR total score as the dependent variable and six-minute walk test distance as the primary independent variable, adjusting for potential confounders including age, sex, WHO functional class, pulmonary hypertension etiology, BNP/NT-proBNP level, pulmonary artery pressure, and cardiac output.

    Time frame: 7- 28 days

  12. Correlation between echocardiographic pulmonary artery systolic pressure and EmPHasis-10-BR score

    Echocardiographic pulmonary artery systolic pressure (PASP), measured in mmHg, will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis.

    Time frame: 7-28 days

  13. Correlation between echocardiographic TAPSE/PASP ratio and EmPHasis-10-BR score

    The echocardiographic tricuspid annular plane systolic excursion to pulmonary artery systolic pressure ratio (TAPSE/PASP), measured in mm/mmHg, will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis.

    Time frame: 7-28 days

  14. Correlation between echocardiographic right atrial area and EmPHasis-10-BR score

    Echocardiographic right atrial area, measured in cm², will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis

    Time frame: 7-28days

  15. Correlation between cardiac magnetic resonance right ventricular ejection fraction and EmPHasis-10-BR score

    Right ventricular ejection fraction (RVEF), assessed by cardiac magnetic resonance imaging and expressed as a percentage, will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis.

    Time frame: 7-28 days

  16. Correlation between cardiac magnetic resonance right atrial area and EmPHasis-10-BR score

    Right atrial area, assessed by cardiac magnetic resonance imaging and measured in cm², will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis.

    Time frame: 7- 28 days

  17. Correlation between peak oxygen uptake and EmPHasis-10-BR score

    Peak oxygen uptake (VO₂ peak), assessed by cardiopulmonary exercise testing and expressed in mL/kg/min, will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis.

    Time frame: 7-28 days

  18. Correlation between VE/VCO₂ slope and EmPHasis-10-BR score

    The VE/VCO₂ slope, assessed by cardiopulmonary exercise testing and expressed in L/L, will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis.

    Time frame: 7-28 days

  19. Correlation between peak oxygen pulse and EmPHasis-10-BR score

    Peak oxygen pulse, assessed by cardiopulmonary exercise testing and expressed in mL/beat, will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis.

    Time frame: 7-28 days

  20. Correlation between mean pulmonary artery pressure and EmPHasis-10-BR score

    ean pulmonary artery pressure, measured by right heart catheterization and expressed in mmHg, will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis.

    Time frame: 7-28 days

  21. Correlation between right atrial pressure and EmPHasis-10-BR score

    Right atrial pressure, measured by right heart catheterization and expressed in mmHg, will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis.

    Time frame: 7-28 days

  22. Correlation between cardiac index and EmPHasis-10-BR score

    Cardiac index, measured by right heart catheterization and expressed in L/min/m², will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis.

    Time frame: 7-28 days

  23. Correlation between pulmonary vascular resistance and EmPHasis-10-BR score

    Pulmonary vascular resistance, measured by right heart catheterization and expressed in Wood units, will be evaluated in relation to the total score of the EmPHasis-10-BR questionnaire using Spearman rank correlation and linear regression analysis.

    Time frame: 7-28 days

07

Study locations

1 of 1 sites recruiting
08

References and documents

Individual participant data

Plan to share: No

No publications or documents are linked to this record.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reached

Started Mar 2026 (actual). Primary completion is estimated for Mar 2027, 12 months after the start.

How these figures are worked out, and which studies are left out of them.

Registered
Dec 22, 2025
First posted
Sep 16, 2026
StartActual
Mar 1, 2026
Primary completionEst.
Mar 2027
CompletionEst.
Jul 2027
Last update
Sep 16, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Sep 16, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT07822997
Responsible party
Marcelo Basso Gazzana (Physician assistant pulmonologist; Professor of Graduate Program in Pneumological Sciences,, Hospital de Clinicas de Porto Alegre) — Principal investigator
First posted
Sep 16, 2026
Start date
Mar 1, 2026
Primary completion
Mar 2027 (estimated)
Completion
Jul 2027 (estimated)
Last update
Sep 16, 2026

Study contacts

Bruna H Bianchini, MD
Contact
bhbianchini@hcpa.edu.br
55+ 48 991023563
Marcelo B Gazzana, MD, PhD
Contact
mbgazzana@hcpa.edu.br
Marcelo B Gazzana, MD, PhD
principal investigator · Hospital de Clinicas de Porto Alegre

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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