Risk assessment in pulmonary arterial hypertension
| Determinants of prognosis | Estimated 1-year mortality | ||
|---|---|---|---|
| Low-risk (< 5%) | Intermediate risk (5%–10%) | High risk (> 10%) | |
| Clinical signs of right heart failure | Absent | Absent | Present |
| Progression of symptoms | No | Slow | Rapid |
| Syncope | No | Occasional | Repeated |
| WHO functional class | I, II | III | IV |
| 6-minute walk distance | > 440 m | 165–440 m | < 165 m |
| Natriuretic peptide levels | BNP < 50 ng/L NT-proBNP < 300 ng/mL | BNP 50–300 ng/L NT-proBNP 300–1,400 ng/L | BNP > 300 ng/L NT-proBNP > 1,400 ng/L |
| Imaging (echocardiography, CMRI) | RA area < 18 cm2 No pericardial effusion | RA area 18–26 cm2 No or minimal pericardial effusion | RA area > 26 cm2 Pericardial effusion |
| Hemodynamics | RA pressure < 8 mm Hg CI ≥ 2.5 L/min/m2 SvO2 > 65% | RA pressure 8–14 mm Hg CI 2.0–2.4 L/min/m2 Svo2 60%–65% | RA pressure > 14 mm Hg CI < 2.0 L/min/m2 Svo2 < 60% |
CI = cardiac index; CMRI = cardiac magnetic resonance imaging; NT-proBNP = N-terminal pro-B-type natriuretic peptide; RA = right atrium; Svo2 = saturation of venous oxygen; WHO = World Health Organization. Reproduced with permission of the European Society of Cardiology and the European Respiratory Society. European Respiratory Journal Oct 2015; 46(4):903–975. doi:10.1183/13993003.01032-2015