Comparison of European Society of Cardiology (ESC)/European Respiratory Society (ERS) and REVEAL 2.0 prognostic tools

VariableESC/ERS guidelinesREVEAL 2.0 risk score calculator#
Low risk: <5%Intermediate risk: 5–10%High risk: >10%1 unless indicated+1+2 unless indicated
WHO PH Group 1 subgroupAPAH-CTDHeritable PoPH (+3)
DemographicsMale, age >60 years
Clinical signs of right heart failureAbsentAbsentPresent
ComorbiditieseGFR<60 mL·min−1/1.73 m2 or renal insufficiency
Symptom progressionNoSlowRapid
Vital signsSBP <110 mmHg
HR >96 beats·min−1
SyncopeNoOccasional syncopeRepeated syncope
All-cause hospitalisations ≤6 months≥1
6MWD>440 m165–440 m<165 m≥440 m (−2)
320–<440 m
<165 m
CPETPeak V′O2 >15 mL·min−1·kg−1
(>65% pred)
VE/V′CO2 slope <36
Peak V′O2 11–15 mL·min−1·kg−1
(35–65% pred)
VE/V′CO2 slope 36–44.9
Peak V′O2 <11 mL·min−1·kg−1
(<35% pred)
VE/V′CO2 slope ≥44.9
BNP/NT-proBNP plasma levelsBNP <50 ng·L−1
NT-proBNP <300 ng·L−1
BNP 50–300 ng·L−1
NT-proBNP 300–1400 ng·L−1
BNP >500 ng·L−1
NT-proBNP >1400 ng·L−1
BNP<50 ng·L−1
NT-proBNP <300 ng·L−1
BNP 200–800 ng·L−1BNP ≥800 ng·L−1
NT-proBNP ≥1100 ng·L−1
Imaging/echocardiographyRA area <18 cm2
No pericardial effusion
RA area 18–26 cm2
No or minimal pericardial effusion
RA area >26 cm2
Pericardial effusion
Pericardial effusion
Haemodynamics/right heart catheterisationRAP <8 mmHg
CI ≥2.5 L/min/m2
SvO2 >65%
RAP 8–14 mmHg
CI 2.0–2.4 L/min/m2
SvO2 60–65%
RAP >14 mmHg
CI <2.0 L/min/m2
SvO22 <60%
PVR <5 Wood unitsMean RAP >20 mmHg within 1 year
Pulmonary function testDLCO <40% pred

ESC/ERS guidelines state that, while not all variables need to be assessed, WHO FC and at least one measurement of exercise capacity (6MWD or CPET) should be taken as a minimum, and assessment of right ventricular (RV) function (BNP/NT-proBNP or echocardiography) is recommended. REVEAL 2.0 includes 11 variables including modifiable and non-modifiable with each score corresponding to a risk for mortality at 1 year. To mirror the ESC/ERS approach the REVEAL score can also be split into three groups (low risk ≤6, intermediate risk 7–8, high risk ≥9) [1, 9]. REVEAL: Registry to Evaluate Early And Long-term PAH Disease Management; WHO: World Health Organization; PH: pulmonary hypertension; NYHA: New York Heart Association; FC: functional class; CPET: cardiopulmonary exercise test; 6MWD: 6-min walk distance; BNP: B-type natriuretic peptide; NT-proBNP: N-terminal pro-hormone of BNP; APAH-CTD: pulmonary arterial hypertension associated with connective tissue disease; PoPH: portopulmonary hypertension; eGFR: estimated glomerular filtration rate; SBP: systolic blood pressure; HR: heart rate; VO2: oxygen consumption; VE: minute ventilation; VCO2: carbon dioxide production; RA: right atrium; RAP: right atrial pressure; CI: cardiac index; SvO2: mixed venous oxygen saturation; PVR: pulmonary vascular resistance; DLCO: diffusing capacity of the lungs for carbon monoxide. #: add/subtract for each variable to get overall score.