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Risk stratification of pulmonary hypertension

ESC/ERS 3-risk strata: SPAHR/COMPERA 1.0

ESC/ERS 4-risk strata/ COMPERA 2.0

TAPSE/sPAP (mm/mmHg)

REVEAL 2.0

WHO group 1  subgroup

Male > 60 years

All causes hospitalization ≤ 6 months

eGFR < 60 ml/min/1.73 m² or renal insufficiency

Systolic blood pressure, mmHg

Heart rate, BPM

WHO-FC

6MWD, m

BNP, ng/L or

NT-proBNP, ng/L

PE on echocardiogram

DLCO ≤ 40% pred

RAP > 20 mmHg within 1 year

PVR < 5 WU

REVEAL Lite 2

eGFR < 60 ml/min/1.73 m² or renal insufficiency

Systolic blood pressure, mmHg

Heart rate, BPM

WHO-FC  **

6MWD, m  **

BNP, ng/L or

NT-proBNP, ng/L   **

FPHR noninvasive

Low-risk parameters

FPHR invasive

Low-risk parameters

Result

Reference

Dardi F, Boucly A, Benza R, Frantz R, Mercurio V, Olschewski H, et al. Risk stratification and treatment goals in pulmonary arterial hypertension. Eur Respir J [Internet]. 2024 Oct 31;64(4):2401323. Available from: https://publications.ersnet.org//content/erj/64/4/2401323.abstract

Colalillo A, Hoffmann-Vold AM, Pellicano C, Romaniello A, Gabrielli A, Hachulla E, et al. The role of TAPSE/sPAP ratio in predicting pulmonary hypertension and mortality in the systemic sclerosis EUSTAR cohort. Autoimmunity Reviews [Internet]. 2023 Apr 1;22(4):103290. Available from: https://www.sciencedirect.com/science/article/pii/S1568997223000241

Palacios-Moguel P, Cueto-Robledo G, González-Pacheco H, Ortega-Hernández J, Torres-Rojas MB, Navarro-Vergara DI, et al. The role of the TAPSE/sPAP ratio as a predictor of mortality in Pulmonary Arterial Hypertension: Its value for patient risk stratification. JHLT Open [Internet]. 2025 Feb 1;7:100168. Available from: https://www.sciencedirect.com/science/article/pii/S2950133424001174

Benza RL, Gomberg-Maitland M, Elliott CG, Farber HW, Foreman AJ, Frost AE, McGoon MD, Pasta DJ, Selej M, Burger CD, Frantz RP. Predicting Survival in Patients With Pulmonary Arterial Hypertension: The REVEAL Risk Score Calculator 2.0 and Comparison With ESC/ERS-Based Risk Assessment Strategies. Chest. 2019 Aug;156(2):323-337. doi: 10.1016/j.chest.2019.02.004. Epub 2019 Feb 14. PMID: 30772387.

Évora García M, Pérez Peñate G, Ojeda Suárez C, Galván Fernández H, Veliz Flores I, Villar Hernández J, et al. REVEAL Lite 2 risk assessment in Pulmonary Hypertension associated to respiratory disease. Eur Respir J [Internet]. 64(suppl 68):PA3421. Available from: https://publications.ersnet.org//content/erj/64/suppl_68/PA3421

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