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.

风险分层在预测结局和指导肺动脉高压 （PAH） 患者的治疗方面发挥着越来越大的作用。最具预测性的预后因素是三个无创参数（世界卫生组织功能分级、6 分钟步行距离和利钠肽），这些参数包含在所有当前验证的风险分层工具中。然而，由于主要与 PAH 严重程度的特异性降低相关的局限性，这些变量可能并不总是足以单独指导个体化治疗决策。此外，随着有效的联合治疗方案和新兴的 PAH 疗法，与肺血管重塑相关的标志物有望在指导 PAH 患者治疗方面变得越来越重要。虽然使用经过验证的风险工具进行评估，达到低死亡风险仍然是一个重要的治疗目标，但初步数据表明，有创血流动力学和心脏影像学检查可能会在指导治疗决策方面增加价值。