Development and Validation of an Abridged Version of the REVEAL 2.0 Risk Score Calculator, REVEAL Lite 2, for Use in Patients With Pulmonary Arterial Hypertension

Abstract

BackgroundAchievement of low-risk status is a treatment goal in pulmonary arterial hypertension (PAH). Risk assessment often is performed using multiparameter tools, such as the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) risk calculator. Risk calculators that assess fewer variables without compromising validity may expedite risk assessment in the routine clinic setting. We describe the development and validation of REVEAL Lite 2, an abridged version of REVEAL 2.0.Research QuestionCan a simplified version of the REVEAL 2.0 risk assessment calculator for patients with PAH be developed and validated?Study Design and MethodsREVEAL Lite 2 includes six noninvasive variables—functional class (FC), vital signs (systolic BP [SBP] and heart rate), 6-min walk distance (6MWD), brain natriuretic peptide (BNP)/N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and renal insufficiency (by estimated glomerular filtration rate [eGFR])—and was validated in a series of analyses (Kaplan-Meier, concordance index, Cox proportional hazard model, and multivariate analysis).ResultsREVEAL Lite 2 approximates REVEAL 2.0 at discriminating low, intermediate, and high risk for 1-year mortality in patients in the REVEAL registry. The model indicated that the most highly predictive REVEAL Lite 2 parameter was BNP/NT-proBNP, followed by 6MWD and FC. Even if multiple, less predictive variables (heart rate, SBP, eGFR) were missing, REVEAL Lite 2 still discriminated among risk groups.InterpretationREVEAL Lite 2, an abridged version of REVEAL 2.0, provides a simplified method of risk assessment that can be implemented routinely in daily clinical practice. REVEAL Lite 2 is a robust tool that provides discrimination among patients at low, intermediate, and high risk of 1-year mortality.Trial RegistryClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov; Achievement of low-risk status is a treatment goal in pulmonary arterial hypertension (PAH). Risk assessment often is performed using multiparameter tools, such as the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) risk calculator. Risk calculators that assess fewer variables without compromising validity may expedite risk assessment in the routine clinic setting. We describe the development and validation of REVEAL Lite 2, an abridged version of REVEAL 2.0. Can a simplified version of the REVEAL 2.0 risk assessment calculator for patients with PAH be developed and validated? REVEAL Lite 2 includes six noninvasive variables—functional class (FC), vital signs (systolic BP [SBP] and heart rate), 6-min walk distance (6MWD), brain natriuretic peptide (BNP)/N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and renal insufficiency (by estimated glomerular filtration rate [eGFR])—and was validated in a series of analyses (Kaplan-Meier, concordance index, Cox proportional hazard model, and multivariate analysis). REVEAL Lite 2 approximates REVEAL 2.0 at discriminating low, intermediate, and high risk for 1-year mortality in patients in the REVEAL registry. The model indicated that the most highly predictive REVEAL Lite 2 parameter was BNP/NT-proBNP, followed by 6MWD and FC. Even if multiple, less predictive variables (heart rate, SBP, eGFR) were missing, REVEAL Lite 2 still discriminated among risk groups. REVEAL Lite 2, an abridged version of REVEAL 2.0, provides a simplified method of risk assessment that can be implemented routinely in daily clinical practice. REVEAL Lite 2 is a robust tool that provides discrimination among patients at low, intermediate, and high risk of 1-year mortality. ClinicalTrials.gov; No.: NCT00370214; URL: www.clinicaltrials.gov; Take-home PointsStudy Question: To develop and validate a simplified version of the REVEAL 2.0 risk assessment calculator for patients with PAH.Results: REVEAL Lite 2, an abridged version of REVEAL 2.0 that uses six rather than 13 variables, approximates REVEAL 2.0 at discriminating low, intermediate, and high risk for 1-year mortality in patients in the REVEAL Registry.Interpretation: REVEAL Lite 2 provides a simplified and robust method of risk assessment for implementation in routine clinical practice.FOR EDITORIAL COMMENT, SEE PAGE 14Despite advances in the treatment of pulmonary arterial hypertension (PAH; World Health Organization [WHO] group 1 pulmonary hypertension), no cure exists for this progressive and ultimately fatal disease. However, with timely and effective clinical intervention, clinical status and survival are improved. The current goal of PAH treatment is to enable patients to achieve a low mortality risk status, which has been associated with improved outcomes.1Galiè N. Humbert M. Vachiery J.L. et al.2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).Eur Heart J. 2016; 37: 67-119Crossref PubMed Scopus (4388) Google Scholar, 2Benza R.L. Farber H.W. Selej M. Gomberg-Maitland M. Assessing risk in pulmonary arterial hypertension: what we know, what we don’t.Eur Respir J. 2017; 50: 1701353Crossref PubMed Scopus (22) Google Scholar, 3Farber H.W. Benza R.L. Risk assessment tools in pulmonary arterial hypertension. Prognosis for prospective trials?.Am J Respir Crit Care Med. 2018; 197: 843-845Crossref PubMed Scopus (12) Google Scholar, 4Weatherald J. Boucly A. Sahay S. Humbert M. Sitbon O. The low-risk profile in pulmonary arterial hypertension. Time for a paradigm shift to goal-oriented clinical trial endpoints?.Am J Respir Crit Care Med. 2018; 197: 860-868Crossref PubMed Scopus (39) Google Scholar, 5Galiè N. Channick R.N. Frantz R.P. et al.Risk stratification and medical therapy of pulmonary arterial hypertension.Eur Respir J. 2019; 53: 1801889Crossref PubMed Scopus (521) Google Scholar To enable such outcomes, assessments of mortality risk should be made at PAH diagnosis and at regular intervals during follow-up. The results of these assessments should be used to guide management, including proactive adjustment of treatment if a low mortality risk status is not achieved.1Galiè N. Humbert M. Vachiery J.L. et al.2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).Eur Heart J. 2016; 37: 67-119Crossref PubMed Scopus (4388) Google Scholar,5Galiè N. Channick R.N. Frantz R.P. et al.Risk stratification and medical therapy of pulmonary arterial hypertension.Eur Respir J. 2019; 53: 1801889Crossref PubMed Scopus (521) Google Scholar Study Question: To develop and validate a simplified version of the REVEAL 2.0 risk assessment calculator for patients with PAH. Results: REVEAL Lite 2, an abridged version of REVEAL 2.0 that uses six rather than 13 variables, approximates REVEAL 2.0 at discriminating low, intermediate, and high risk for 1-year mortality in patients in the REVEAL Registry. Interpretation: REVEAL Lite 2 provides a simplified and robust method of risk assessment for implementation in routine clinical practice. FOR EDITORIAL COMMENT, SEE PAGE 14 Current best practice is for risk assessments to be made using multiparameter risk assessment tools, such as the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) risk calculator versions 1.0 or 2.0,6Benza R.L. Gomberg-Maitland M. Miller D.P. et al.The REVEAL Registry risk score calculator in patients newly diagnosed with pulmonary arterial hypertension.Chest. 2012; 141: 354-362Abstract Full Text Full Text PDF PubMed Scopus (396) Google Scholar,7Benza R.L. Gomberg-Maitland M. Elliott C.G. et al.Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies.Chest. 2019; 156: 323-337Abstract Full Text Full Text PDF PubMed Scopus (342) Google Scholar the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) method,8Hoeper M.M. Kramer T. Pan Z. et al.Mortality in pulmonary arterial hypertension: prediction by the 2015 European pulmonary hypertension guidelines risk stratification model.Eur Respir J. 2017; 50: 1700740Crossref PubMed Scopus (427) Google Scholar the Swedish PAH Register method,9Kylhammar D. Kjellström B. Hjalmarsson C. et al.A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension.Eur Heart J. 2018; 39: 4175-4181Crossref PubMed Scopus (339) Google Scholar the French Pulmonary Hypertension Registry (FPHR) method,10Boucly A. Weatherald J. Savale L. et al.Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension.Eur Respir J. 2017; 50: 1700889Crossref PubMed Scopus (451) Google Scholar and the Bologna strategy.11Dardi F, Palazzini M, Gotti E, et al. Simplified table for risk stratification in patients with different types of pulmonary arterial hypertension. Poster presented at: European Society of Cardiology Annual Meeting; August 25-29, 2018; Munich, Germany. Poster P4538.Google Scholar REVEAL 1.0 and 2.0 estimate PAH mortality risk by assigning scores using up to 12 or 13 variables, The scores are used to patients risk R.L. Gomberg-Maitland M. Miller D.P. et al.The REVEAL Registry risk score calculator in patients newly diagnosed with pulmonary arterial hypertension.Chest. 2012; 141: 354-362Abstract Full Text Full Text PDF PubMed Scopus (396) Google Scholar,7Benza R.L. Gomberg-Maitland M. Elliott C.G. et al.Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies.Chest. 2019; 156: 323-337Abstract Full Text Full Text PDF PubMed Scopus (342) Google Scholar REVEAL 2.0 variables and REVEAL 1.0 to risk The and Bologna up to six variables and mortality risk in the European Society of Respiratory Society pulmonary hypertension M.M. Kramer T. Pan Z. et al.Mortality in pulmonary arterial hypertension: prediction by the 2015 European pulmonary hypertension guidelines risk stratification model.Eur Respir J. 2017; 50: 1700740Crossref PubMed Scopus (427) Google A. Weatherald J. Savale L. et al.Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension.Eur Respir J. 2017; 50: 1700889Crossref PubMed Scopus (451) Google F, Palazzini M, Gotti E, et al. Simplified table for risk stratification in patients with different types of pulmonary arterial hypertension. Poster presented at: European Society of Cardiology Annual Meeting; August 25-29, 2018; Munich, Germany. Poster P4538.Google Scholar clinical REVEAL 2.0, with and risk discrimination than of the ESC/ERS-based risk assessment R.L. Gomberg-Maitland M. Elliott C.G. et al.Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies.Chest. 2019; 156: 323-337Abstract Full Text Full Text PDF PubMed Scopus (342) Google Scholar The for timely and regular risk assessment in PAH is N. Humbert M. Vachiery J.L. et al.2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).Eur Heart J. 2016; 37: 67-119Crossref PubMed Scopus (4388) Google Scholar,5Galiè N. Channick R.N. Frantz R.P. et al.Risk stratification and medical therapy of pulmonary arterial hypertension.Eur Respir J. 2019; 53: 1801889Crossref PubMed Scopus (521) Google A. Weatherald J. Savale L. et al.Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension.Eur Respir J. 2017; 50: 1700889Crossref PubMed Scopus (451) Google R.L. J. M. Risk assessment in pulmonary arterial hypertension the and of 2018; Google A. Humbert M. Risk assessment in pulmonary arterial hypertension.Eur Respir 2016; PubMed Scopus Google that risk assessment in the clinical is A. of risk of in pulmonary arterial hypertension: an of clinical 2019; PubMed Scopus Google Scholar to implementation been including the of M, M, Risk assessment tools in pulmonary arterial hypertension a of and to presented at: PAH 2019; Scholar the of that to be a of patients risk of and a to A. of risk of in pulmonary arterial hypertension: an of clinical 2019; PubMed Scopus Google Scholar To expedite risk assessment in the comprehensive for patients may be and risk assessment tools using fewer variables may be To this we developed simplified risk REVEAL Lite 1 and REVEAL Lite are the developed and validated REVEAL 2.0 risk R.L. Gomberg-Maitland M. Elliott C.G. et al.Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies.Chest. 2019; 156: 323-337Abstract Full Text Full Text PDF PubMed Scopus (342) Google M. et validation of the REVEAL 2.0 risk score with the and Pulmonary Hypertension Registry Full Text Full Text PDF PubMed Scopus Google Gomberg-Maitland M. M. et al.Risk stratification in pulmonary arterial hypertension using Respir J. Scopus Google Scholar in an abridged REVEAL Lite 1 uses noninvasive variables, REVEAL Lite 2 uses six and noninvasive M, et al. of risk discrimination the REVEAL 2.0 the French Pulmonary Registry and the Bologna in patients with pulmonary arterial hypertension. Poster presented at: Society International 2019; Poster Scholar we results analyses during development and validation of REVEAL Lite REVEAL Lite 2 was developed using patients in the REVEAL The used for REVEAL 2.0 development was used for the current REVEAL Lite 2 in REVEAL were if were of or at for PAH pulmonary and 12 of follow-up the of the for development of the REVEAL 2.0 was for these were the analyses if were in a clinical trial at or if a 1 of The and variables and associated in the REVEAL 2.0 and REVEAL Lite 2 risk calculators are presented in REVEAL Lite 2 is REVEAL 2.0, includes six noninvasive and Heart Association or class (FC), vital signs (systolic BP [SBP] and heart rate), 6-min walk distance (6MWD), brain natriuretic peptide (BNP)/N-terminal prohormone of brain natriuretic peptide (NT-proBNP), renal insufficiency estimated glomerular filtration rate or as as by the was REVEAL 2.0 and REVEAL Lite 2, patients were risk to ESC/ERS N. Humbert M. Vachiery J.L. et al.2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).Eur Heart J. 2016; 37: 67-119Crossref PubMed Scopus (4388) Google Scholar,7Benza R.L. Gomberg-Maitland M. Elliott C.G. et al.Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies.Chest. 2019; 156: 323-337Abstract Full Text Full Text PDF PubMed Scopus (342) Google Scholar the REVEAL 2.0 assessment, and the 1-year mortality in the REVEAL scores to a score and was low a score of or was and a score of or was high R.L. Gomberg-Maitland M. Elliott C.G. et al.Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies.Chest. 2019; 156: 323-337Abstract Full Text Full Text PDF PubMed Scopus (342) Google Scholar the REVEAL Lite 2 assessment scores 1 to a score 1 and was low a score of or was and a score of or was high Risk was for risk calculators using a of the REVEAL 1 To for REVEAL Lite 2 to REVEAL 2.0, the used for REVEAL 2.0 was used for REVEAL Lite REVEAL Lite 2 scores at of were for patients in this of was used for REVEAL Lite 2 in the REVEAL 2.0 and REVEAL Lite 2 Risk and Risk 2.0 Lite 2 hypertension: or by clinical if is not or the 1 of scores of scores parameter not in REVEAL Lite 6-min walk brain natriuretic of the for estimated glomerular filtration heart prohormone of brain natriuretic Heart PAH pulmonary arterial pulmonary REVEAL Registry to Evaluate Early and Long-Term PAH Disease heart World Health table in a parameter not in REVEAL Lite 6MWD 6-min walk brain natriuretic of the for estimated glomerular filtration heart prohormone of brain natriuretic Heart PAH pulmonary arterial pulmonary REVEAL Registry to Evaluate Early and Long-Term PAH Disease heart World Health REVEAL Lite 2 is versions of the REVEAL risk assessment tools 1.0 and 2.0. of the used in development been for REVEAL and REVEAL R.L. Gomberg-Maitland M. Elliott C.G. et al.Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies.Chest. 2019; 156: 323-337Abstract Full Text Full Text PDF PubMed Scopus (342) Google Scholar and of the development of REVEAL 2.0 were used in the current in which risk was the assessment at 12 follow-up or an score of was for The six noninvasive and were to the REVEAL 2.0 risk heart rate 6MWD renal insufficiency The Cox proportional hazard model with the six as variables and survival as the was used to the in which was used to the of these The Cox proportional hazard model was used to the survival rate risk concordance was used as a and the associated were used to the discrimination of the risk assessment The method was used to estimate 1-year survival for of the risk score for risk calculators 2.0 and REVEAL Lite were to the REVEAL 2.0 and REVEAL Lite 2 risk group were used to the of or were the model the discrimination of REVEAL Lite analyses were using version of the patients in REVEAL Registry were for in analyses of patients with for and of were R.L. Gomberg-Maitland M. Elliott C.G. et al.Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies.Chest. 2019; 156: 323-337Abstract Full Text Full Text PDF PubMed Scopus (342) Google Scholar and clinical for these patients at 1 are presented in of patients PAH and PAH patients were as and at 1 1 of or or group PAH not or associated Congenital heart or were for Heart PAH pulmonary arterial World Health not or were for table in a Heart PAH pulmonary arterial World Health survival to by REVEAL 2.0 and REVEAL Lite 2 are in and of risk risk The results of the hazard and for 1-year survival are presented in that REVEAL Lite 2 approximates the REVEAL 2.0 risk calculator at discriminating among patients at low, intermediate, or high risk for 1-year mortality was the of the were using or The using were and for REVEAL 2.0 and REVEAL Lite 2, The using the were and for REVEAL 2.0 and REVEAL Lite 2, REVEAL 2.0 was developed at 12 of follow-up we REVEAL Lite 2 provides discrimination at the of we REVEAL Lite 2 to at PAH the was We the for and using REVEAL Lite using the were and using were and for and and for of and Risk of at 1 2.0 Lite 2 concordance hazard not 1 for of table in a concordance hazard not 1 for of Cox proportional hazard multivariate that variables and scores were of survival and that risk score was associated with risk of 1-year survival was as is the is the and is the The of the is the of the Cox model were to be highly predictive 2 for with the of heart rate and or However, is to that patients in the or disease. The model indicated that the most highly predictive parameter was 2 for high followed by 6MWD 2 for and or 2 REVEAL 2.0 and REVEAL Lite 2 was using the method and is presented in patients and variables as the the using the method was at risk scores were patients without or 6MWD the improved to the of the to 1 or 2, no was as low risk using REVEAL 2.0 was to be at high risk using REVEAL Lite of REVEAL 2.0 and REVEAL Lite Lite patients as REVEAL patients with for and 6MWD REVEAL 1 for of patients as patients with for and 6MWD table in a 1 for of The of variables was using of and variables were The results are presented in REVEAL Lite 2 discrimination risk presented in the not variables REVEAL Lite 2 are of the variables of most are BNP/NT-proBNP, and or FC. was in 6MWD was in and or was in patients of six variables were missing, the was of the variables was associated with in to variables the variables were SBP, heart rate, or a REVEAL Lite 2 still discrimination risk groups. However, variables the variables and or were missing, the be which is the for of Risk REVEAL Lite of patients with variables at BNP/NT-proBNP, or renal SBP, 2 in the of Risk or renal 1 renal or renal or renal or renal renal or or renal 2 or variables BNP/NT-proBNP, and or Lite 2 and renal Lite 2 and renal Lite 2 and renal 2 or variables SBP, renal and and renal or and or renal and renal or SBP, renal and or or 2, and for of of patients with variables at BNP/NT-proBNP, or renal SBP, table in a 2, and for of REVEAL Lite 2 is a multiparameter risk assessment tool for patients with PAH that provides a simplified and robust risk calculator for routine clinical is an abridged version of the REVEAL 2.0 risk calculator that uses six than noninvasive and REVEAL Lite 2 approximates REVEAL 2.0 at discriminating among patients in the REVEAL Registry at low, intermediate, and high risk for 1-year mortality the using intermediate, or high or the The model indicated that the most highly predictive parameter in REVEAL Lite 2 the 2 was BNP/NT-proBNP, followed by 6MWD and or FC. of the of REVEAL Lite 2 and REVEAL 2.0 was to be variables were as using patients without or 6MWD the development of REVEAL Lite 2, we a series of analyses to validate the results using this abridged risk calculator by with by the risk REVEAL 2.0. the of REVEAL 2.0 and REVEAL Lite 2, using patients in the REVEAL including with of the most was that no patients as at low risk using REVEAL 2.0 were to be at high risk using REVEAL Lite a of patients to be at low risk using REVEAL 2.0 were as at risk using REVEAL Lite 2 REVEAL Lite 2 has clinical in patients can be used as a and method for patients to a low risk for 1 of mortality. Risk discrimination of patients in REVEAL using REVEAL Lite 2 than that using risk assessment ESC/ERS guidelines versions of the method and were used to assess risk in the of patients the were and F, Palazzini M, Gotti E, et al. Simplified table for risk stratification in patients with different types of pulmonary arterial hypertension. Poster presented at: European Society of Cardiology Annual Meeting; August 25-29, 2018; Munich, Germany. Poster P4538.Google these are than the using REVEAL Lite 2 improved discrimination may be REVEAL Lite 2 variables are the method for the method be used if is missing, the for REVEAL Lite 2 provides the discrimination six variables are REVEAL Lite 2 still provides discrimination if of six variables are including at variables the variables are as REVEAL Lite 2 risk The that the discriminating variables still REVEAL Lite 2 to assess risk in patients is with the and is REVEAL Lite 2 provides the to among low, intermediate, and high analyses is that the for risk discrimination using REVEAL Lite 2 was the risk intermediate, and was robust the risk scores were should risk are and are to patients with risk scores that not risk can to treatment with risk and in the in the 1-year rate and to that risk to be or that using variables risk rather than risk should be clinical in as as may a risk assessment that fewer variables as REVEAL Lite than we at the of REVEAL Lite 2 and that if of the variables as were heart rate, SBP, and REVEAL Lite 2 still discrimination among risk groups. However, in clinical practice be for patients to be of the six variables used in REVEAL Lite REVEAL Lite 2 discrimination at that can be used at the in routine clinical practice patients of using REVEAL Lite 2 is that risk calculator REVEAL Lite 2 uses of is by assigning an score to a risk this score is proportional to to the risk The of the of and R.L. Gomberg-Maitland M. Elliott C.G. et al.Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies.Chest. 2019; 156: 323-337Abstract Full Text Full Text PDF PubMed Scopus (342) Google Scholar risk assessment tools, such as the and Bologna M.M. Kramer T. Pan Z. et al.Mortality in pulmonary arterial hypertension: prediction by the 2015 European pulmonary hypertension guidelines risk stratification model.Eur Respir J. 2017; 50: 1700740Crossref PubMed Scopus (427) Google Scholar, D. Kjellström B. Hjalmarsson C. et al.A comprehensive risk stratification at early follow-up determines prognosis in pulmonary arterial hypertension.Eur Heart J. 2018; 39: 4175-4181Crossref PubMed Scopus (339) Google Scholar, A. Weatherald J. Savale L. et al.Risk assessment, prognosis and guideline implementation in pulmonary arterial hypertension.Eur Respir J. 2017; 50: 1700889Crossref PubMed Scopus (451) Google Scholar not of variables and or rather than assigning different predictive and by model in the REVEAL risk assessment to risk analyses in a of patients in the REVEAL Registry that the risk calculator REVEAL 2.0 has discrimination than and R.L. Gomberg-Maitland M. Elliott C.G. et al.Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies.Chest. 2019; 156: 323-337Abstract Full Text Full Text PDF PubMed Scopus (342) Google Scholar and that REVEAL Lite 2 has discrimination than and Bologna risk assessment M, et al. of risk discrimination the REVEAL 2.0 the French Pulmonary Registry and the Bologna in patients with pulmonary arterial hypertension. Poster presented at: Society International 2019; Poster Scholar the clinical we that the REVEAL 2.0 score be used for to and in The abridged REVEAL Lite 2 be used in these to a using a the score should be used for assessments and the abridged score should be used in to and to that patients in the low-risk We that if the abridged score an in risk status, a REVEAL 2.0 score should be should be or REVEAL Lite 2 is to rather than REVEAL 2, and to of REVEAL Lite 2 routine clinical practice. analyses we used a a REVEAL to REVEAL Lite 2 be validated in a and as in group the discrimination in and were as as in the with of than in REVEAL were at PAH the results REVEAL may not be to PAH patients treatment in different clinical The results of the may be to survival we used patients in REVEAL for 1 for in the the for in REVEAL was to a the REVEAL 2.0 risk calculator has been in of the for PAH T. Channick R.N. et and and mortality in pulmonary arterial J Med. PubMed Scopus Google Scholar, O. Channick et for the treatment of pulmonary arterial J Med. PubMed Scopus Google Scholar, C. et therapy with for pulmonary arterial hypertension: a clinical J Respir Crit Care Med. PubMed Scopus Google Scholar, et for the treatment of pulmonary arterial J Med. PubMed Scopus Google Scholar and M. et validation of the REVEAL 2.0 risk score with the and Pulmonary Hypertension Registry Full Text Full Text PDF PubMed Scopus Google Gomberg-Maitland M. M. et al.Risk stratification in pulmonary arterial hypertension using Respir J. Scopus Google Scholar were or in these discrimination of the REVEAL 2.0 risk calculator in and and timely of REVEAL Lite 2 is to in the current to the of REVEAL Lite 2 are including of the tool medical Benza et al. clinical and risk scores used in clinical in PAH. Scholar REVEAL Lite 2 is an abridged version of REVEAL 2.0 that was developed to with a simplified method of risk that can be implemented routinely in clinical practice. with REVEAL 2.0, REVEAL Lite 2 is discrimination patients at low, intermediate, and high 1-year mortality validated REVEAL Lite 2 be used for patients with PAH patients at low risk with not at low of the six variables used in the REVEAL Lite 2 risk calculator that were not should be However, assessment of 1-year mortality risk at REVEAL Lite 2 variables at of the most variables BNP/NT-proBNP, and to be

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