Risk stratification according to the ESC/ERS 2009 guidelines
These parameters have been validated for PAH. Although it is possible that most of them have also some prognostic value in other forms of PH this has not been formally validated.
- For PAH
When one or several parameters listed above, and especially the functional class, are in the “red” bad prognosis zone, the therapy should be reevaluated; this consists in the introduction of a dual drug regimen when the patient is on single drug treatment or a triple drug regimen for the patient under dual combination therapy.
- For other forms of PH
Treatment has to be targeted to the underlying disease. In face of a deteriorating patient, other causes of dyspnea have to be ruled out.
Patients in functional class IV who are potentially eligible for lung transplantation should be immediately referred to a transplantation centre where a pre-transplantation work-up including a right heart catheterization will be performed.