Why the study?
Current validated noninvasive risk stratification parameters have limitations in specificity and may not always suffice in isolation for guiding individualised treatment decisions in PAH.
Risk stratification using noninvasive parameters is crucial in PAH, but invasive hemodynamics and cardiac imaging may provide incremental value for individualized treatment decisions.
Noninvasive PAH risk stratification should remain standard; leaves open incremental value of hemodynamics and imaging pending prospective validation.
Risk stratification has gained an increasing role in predicting outcomes and guiding the treatment of patients with pulmonary arterial hypertension (PAH). The most predictive prognostic factors are three noninvasive parameters (World Health Organization functional class, 6-min walk distance and natriuretic peptides) that are included in all currently validated risk stratification tools. However, suffering from limitations mainly related to reduced specificity of PAH severity, these variables may not always be adequate in isolation for guiding individualised treatment decisions. Moreover, with effective combination treatment regimens and emerging PAH therapies, markers associated with pulmonary vascular remodelling are expected to become of increasing relevance in guiding the treatment of patients with PAH. While reaching a low mortality risk, assessed with a validated risk tool, remains an important treatment goal, preliminary data suggest that invasive haemodynamics and cardiac imaging may add incremental value in guiding treatment decisions.
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Dardi et al. (2024) studied this question.
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