Pulmonary Disorders II
Multivariable Assessment of Mortality Risk to Guide Initial Therapy
Assessment
3-Risk Strata
BNP or NT-proBNP
BNP < 50 ng/L
NT-proBNP < 300 ng/L
BNP 50–800 ng/L
NT-proBNP 300–1100 ng/L
NP > 800 ng/L NT-proBNP
> 1100 ng/L
Echocardiography
parameters
RA area < 18 cm2
TAPSE/sPAP
> 0.32 mm/mm Hg
No pericardial effusion
RA area 18–26 cm2 TAPSE/
sPAP 0.19–0.32 mm/mmHg
Minimal pericardial effusion
RA area > 26 cm2 TAPSE/sPAP
< 0.19 mm/mm Hg
Moderate/large pericardial
effusion
Cardiac magnetic
resonance imaging
RVEF >54%
SVI >40 mL/m2
RVESVI <42 mL/m2
RVEF 37–54%
SVI 26–40 mL/m2
RVESVI 42–54 mL/m2
RVEF < 37% SVI < 26 mL/m2
RVESVI > 54 mL/m2
Hemodynamics
RAP < 8 mm Hg
CI ≥ 2.5 L/min/m2
SVI > 38 mL/m2 SvO2
> 65%
RAP 8–14 mm Hg
CI 2.0–2.4 L/min/m2
SVI 31–38 mL/m2
SvO2 60–65%
RAP >14 mm Hg
CI < 2.0 L/min/m2
SVI < 31 mL/m2
SvO2 < 60%
aTo determine risk category, each variable available is categorized a point value as 1 point (low risk), 2 points (intermediate risk), or 3 points (high risk). The total score
is added and divided by the number of variables assessed. Patients are classified as having low-, intermediate, or high-risk disease if their scores are < 1.5, 1.5-2.49, or
> 2.49, respectively.
BNP, B-type natriuretic peptide; CI, cardiac index; NT-proBNP, N-terminal pro-brain natriuretic peptide; RA, right atrium; RAP, right atrial pressure; sPAP, systolic
pulmonary artery pressure; SvO2, mixed venous oxygen saturation; RVESVI, right ventricular end-systolic volume index; RVEF, right ventricular ejection fraction; SVI,
stroke volume index; TAPSE, tricuspid annular plane systolic excursion; VE/VCO2, ventilatory equivalents for carbon dioxide; VO2, oxygen uptake; WHO-FC, World
Health Organization functional class.
Adapted from Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J
2022;43:3618-731.
Multivariable Assessment of Mortality Risk to Guide Follow-Up Therapy
Assessment
4-Risk Strata
Prognostic determinants
Low
Intermediate/Low
Intermediate/High
High
Pointsa
WHO-FC
I or II
—
III
IV
6-Minute walk distance
> 440 m
320–440 m
165–319 m
< 165 m
BNP or NT-proBNP
< 50 ng/L
< 300 ng/L
50–199 ng/L
300–649 ng/L
200–800 ng/L
650–1100 ng/L
> 800 ng/L
> 1100 ng/L
aDivide the sum of all points by the number of variables and round to the next whole number.
BNP, B-type natriuretic peptide; NT-proBNP, N-terminal pro-brain natriuretic peptide; WHO-FC, World Health Organization functional class.
Adapted from Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J
2022;43:3618-731.
The goal of pharmacotherapy is to achieve and maintain a low-risk status on the recommended
stratification model.
Supportive therapy
Physical activity and rehabilitation under the direction of a PH provider for patients in stable
condition may improve quality of life and 6MWD
Oxygen: Maintain Sao2 of 92% or greater and Pao2 of 60 mm Hg or greater.