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PAH Risk Assessment at Follow-up — EECC MCQ

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ModeratePulmonary Vascular DiseasePAH Risk Assessment at Follow-upEECC

A 45-year-old woman with IPAH on dual oral therapy (ambrisentan + tadalafil) is reassessed at 12 months. She is in WHO FC II, 6MWD 440 m, NT-proBNP 280 pg/mL, cardiac index 2.8 L/min/m², and RA pressure 6 mmHg. How is her risk classified?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Low risk — achieving all low-risk criteria at follow-up is the treatment goal; she should continue current therapy with regular reassessment

The 2022 ESC/ERS PH Guidelines use a multiparametric risk assessment approach based on: WHO FC (I-II = low), 6MWD (>440 m = low), NT-proBNP (<300 pg/mL = low), haemodynamics (RA pressure <8 mmHg and CI >2.5 = low), and other parameters. Achieving a comprehensive low-risk profile at follow-up is the treatment goal (associated with 1-year mortality <5%). This patient meets all low-risk criteria. She should continue her current dual therapy and undergo regular reassessment (6-12 monthly). If she deteriorates to intermediate or high risk, treatment escalation (adding a prostacyclin pathway agent) would be indicated. Importantly, 'low risk' does not mean treatment can be stopped — PAH-specific therapy is lifelong.

Reference: ESC/ERS (2022): Guidelines for Pulmonary Hypertension