Jason Weatherald1,2, Athénaïs Boucly3,4,5, Olivier Sitbon3,4,5. 1. Division of Respirology, Department of Medicine, University of Calgary. 2. Libin Cardiovascular Institute of Alberta, Calgary, Canada. 3. Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay. 4. AP-HP, Service de Pneumologie, Hôpital Bicêtre, Le Kremlin-Bicêtre. 5. INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France.
Abstract
PURPOSE OF REVIEW: Periodic risk stratification is recommended for patients with pulmonary arterial hypertension (PAH). The purpose of this article is to review the available risk stratification tools in PAH. RECENT FINDINGS: Validated tools, such as the REVEAL (Registry to Evaluate Early And Long-term PAH Disease Management) score or European Society of Cardiology/European Respiratory Society (ESC/ERS) risk assessment table incorporate clinical, exercise, imaging, and hemodynamic variables to obtain a multidimensional estimate of prognosis. Recent studies from REVEAL and European registries have further validated these tools and improved our understanding of prognostic factors in PAH. Serial risk assessment over time, especially after treatment initiation or modification, provides more useful information than at a single time point, with changes in risk profiles being particularly informative. A brief, simplified approach includes counting the number of ESC/ERS low-risk criteria achieved, with 3 or 4 low-risk criteria associated with an excellent prognosis. When a more precise estimation of risk is desired, the REVEAL score can delineate five risk groups with 1-year survival rates between 97.3% (low risk) and 50.2% (very high risk). SUMMARY: The REVEAL and ESC/ERS risk table are useful, validated, multidimensional risk stratification tools that should be periodically applied to patients with PAH in practice.
PURPOSE OF REVIEW: Periodic risk stratification is recommended for patients with pulmonary arterial hypertension (PAH). The purpose of this article is to review the available risk stratification tools in PAH. RECENT FINDINGS: Validated tools, such as the REVEAL (Registry to Evaluate Early And Long-term PAH Disease Management) score or European Society of Cardiology/European Respiratory Society (ESC/ERS) risk assessment table incorporate clinical, exercise, imaging, and hemodynamic variables to obtain a multidimensional estimate of prognosis. Recent studies from REVEAL and European registries have further validated these tools and improved our understanding of prognostic factors in PAH. Serial risk assessment over time, especially after treatment initiation or modification, provides more useful information than at a single time point, with changes in risk profiles being particularly informative. A brief, simplified approach includes counting the number of ESC/ERS low-risk criteria achieved, with 3 or 4 low-risk criteria associated with an excellent prognosis. When a more precise estimation of risk is desired, the REVEAL score can delineate five risk groups with 1-year survival rates between 97.3% (low risk) and 50.2% (very high risk). SUMMARY: The REVEAL and ESC/ERS risk table are useful, validated, multidimensional risk stratification tools that should be periodically applied to patients with PAH in practice.
Authors: Beate Stubbe; Hans-Jürgen Seyfarth; Janina Kleymann; Michael Halank; Hussam Al Ghorani; Anne Obst; Susanna Desole; Ralf Ewert; Christian F Opitz Journal: BMC Pulm Med Date: 2021-04-21 Impact factor: 3.317
Authors: Valentina Mercurio; Hussein J Hassan; Mario Naranjo; Alessandra Cuomo; Jeremy A Mazurek; Paul R Forfia; Aparna Balasubramanian; Catherine E Simpson; Rachel L Damico; Todd M Kolb; Stephen C Mathai; Steven Hsu; Monica Mukherjee; Paul M Hassoun Journal: J Clin Med Date: 2022-07-12 Impact factor: 4.964