Key criteria found in multiparameter risk assessments
Pulmonary arterial hypertension (PAH) risk stratification methods incorporate results from many tests and assessments you are already using and consolidate the individual results into an overall risk score. At baseline, a comprehensive risk assessment determines the initial treatment regimen. During follow-up visits, the risk score allows you to evaluate whether a patient’s treatment plan is sufficient or needs adjustment.1,2 Today’s treatment goal is to improve risk status, ideally achieving low-risk status in the first year of therapy.1,3,4
The parameters below are common across multiple risk assessment methodologies.2,5-7
NT-proBNP/BNP levels
NT-proBNP and BNP levels are biomarkers of heart strain and possible heart failure. Levels of these biomarkers inversely correlate with survival; higher levels indicate a poorer prognosis for your patient.3,8 In REVEAL Lite 2, NT-proBNP/BNP level was the most predictive noninvasive variable of survival.9
A normal NT-proBNP/BNP level has a 98% sensitivity to exclude the presence of intermediate- and high-risk factors,5 such as RAP >8 mm Hg and CI <2.5 L/min/m2.
Hemodynamics and imaging
In PAH, deterioration of the RV can happen before more obvious declines in other outward measures of risk such as 6MWD and FC.10,11
Monitoring of the RV through tests and imaging such as Echo and RHC is essential for detecting disease progression.1,3
Low-risk criteria for Echo1:
- RA area <18 cm2
- No pericardial effusion
- TAPSE/sPAP >0.32 mm/mm Hg
Low-risk criteria for hemodynamics1:
- RAP <8 mm Hg
- CI ≥2.5 L/min/m2
- SvO2 >65%
- SVI >38 mL/m2
6MWD
The 6MWD assesses exercise capacity, providing insights into how PAH impacts a patient’s ability to perform daily activities. Additionally, the 6MWD is widely used as a primary or secondary endpoint in randomized, controlled PAH trials.1
Download your guide to learn more about administering the 6MWD.
Download 6MWD Guide
Functional class
FC is a measure of how PAH symptoms restrict daily activities. Patients are assigned to 1 of 4 classes based on self-reported activity levels and symptoms.1
Remember, your patients may adjust their activity levels to accommodate their PAH symptoms. It’s important to be aware that patients may feel better because they’re less active.
Download an intake form to monitor your patients’ symptoms at each appointment.
Download Intake Form
WHO classification1
No limitation of physical activity from PAH. Ordinary physical activity does not cause undue dyspnea or fatigue, chest pain, or near-syncope.
Slight limitation of physical activity from PAH. Patient is comfortable at rest, but ordinary physical activity causes undue dyspnea or fatigue, chest pain, or near-syncope.
Marked limitation of physical activity from PAH. Patient is comfortable at rest, but less-than-ordinary physical activity causes undue dyspnea or fatigue, chest pain, or near-syncope.
Inability to carry out any physical activity without symptoms. Patient has signs of right heart failure. Dyspnea and/or fatigue may be present at rest. Discomfort is increased by any physical activity and may result in syncope.