systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.38109/2075-082X-2026-1-9-16systhiper-851Research ArticleОБЗОРНАЯ СТАТЬЯREVIEWСовременные подходы к стратификации риска и оценке прогноза у пациентов с легочной артериальной гипертензиейModern approaches to risk stratification and prognosis assessment in patients with pulmonary arterial hypertensionhttps://orcid.org/0009-0007-8809-2884КаразейЕ. А.KarazeiElena A.

Каразей Елена Александровна, к.м.н., доцент кафедры поликлинической терапии,

пр. Дзержинского, д. 83, к. 1, г. Минск, 220083.

Elena A. Karazei, Cand. Of Scien. (Med.), Associate Professor, Department of Outpatient Therapy,

83/Bldg. 1, Dzerzhinsky Ave.,  Minsk 220083.

alenakara@inbox.ruhttps://orcid.org/0000-0001-6572-8842АдзерихоИ. Э.AdzerikhoIgor E.

Адзерихо Игорь Эдуардович, д.м.н., профессор, профессор кафедры клинической фармакологии и фармакотерапии, Институт повышения квалификации и переподготовки кадров здравоохранения, 

пр. Дзержинского, д. 83, к. 1, г. Минск, 220083.

Igor E. Adzerikho, Dr. Of Scien. (Med.), AProfessor, Department of Clinical Pharmacology and Pharmacotherapy, Institute for Advanced Training and Retraining of Healthcare Personnel,

83/Bldg. 1, Dzerzhinsky Ave.,  Minsk 220083.

adzerikhoigor@mail.ruhttps://orcid.org/0009-0000-5149-9612КоролеваА. А.КoroliovaAlina A.

Королева Алина Анатольевна, к.м.н., доцент, доцент кафедры клинической фармакологии, 

пр. Дзержинского, д. 83, к. 1, г. Минск, 220083.

Alina A. Кoroliova, Cand. Of Scien. (Med.), Associate Professor, Department of Clinical Pharmacology, 

83/Bldg. 1, Dzerzhinsky Ave.,  Minsk 220083.

Zhurdoc@gmail.comhttps://orcid.org/0009-0009-2590-5504КараневичЛ. В.KaranevichLudmila V.

Караневич Людмила Владимировна, врач отделения медицинской реабилитации,

Ульяновская улица, д. 5, г. Минск, 220030.

 

Lyudmila V. Karanevich, Physician, Medical Rehabilitation Department,

5, Ulyanovskaya St., Minsk, 220030.

ludmilakaranevich@rambler.ruУчреждение Образования «Белорусский государственный медицинский университет»БеларусьBelarusian State Medical UniversityBelarusУчреждение Здравоохранения «6-я центральная районная клиническая поликлиника Ленинского района г. Минска»БеларусьHealthcare Institution "6th Central District Clinical Polyclinic of the Leninsky District of Minsk"Belarus202601042026231916Copyright © Каразей Е.А., Адзерихо И.Э., Королева А.А., Караневич Л.В., 20262026Каразей Е.А., Адзерихо И.Э., Королева А.А., Караневич Л.В.Karazei E.A., Adzerikho I.E., Кoroliova A.A., Karanevich L.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/851

Легочная артериальная гипертензия – тяжелое прогрессирующее заболевание с высоким риском смерти, требующее точной оценки прогноза для оптимизации терапии. Стратификация риска играет ключевую роль в прогнозировании выживаемости и выборе тактики лечения. Современные подходы базируются на интегральной оценке клинических, гемодинамических, лабораторных и инструментальных параметров для выявления пациентов с низким, промежуточным и высоким уровнем риска смерти в течение 1 года, что позволяет персонализировать лечение: от монотерапии до агрессивных комбинированных схем и направления на трансплантацию.

Pulmonary arterial hypertension is a severe progressive disease with a high mortality risk, requiring an accurate prognosis assessment to optimize therapy. Risk stratification plays a key role in predicting survival and choosing treatment tactics. Modern approaches in risk stratification are based on an integrated assessment of clinical, hemodynamic, laboratory and instrumental parameters to identify patients with low, intermediate and high risk of death within 1 year, which allows to personalize treatment: from monotherapy to aggressive combination regimens and referral for transplantation.

легочная артериальная гипертензиястратификация рискапараметры прогнозанациональные и международные регистрыинструменты для стратификации рисков легочной артериальной гипертензииpulmonary arterial hypertensionrisk stratificationprognostic parametersnational and international registriespulmonary arterial hypertension risk stratification tools.нетnoReferencesЧазова ИЕ, Мартынюк ТВ, Валиева ЗС и др. Евразийские клинические рекомендации по диагностике и лечению легочной гипертензии. Евразийский Кардиологический журнал. 2020;(1):78-122. https://doi.org/10.38109/2225-1685-2020-1-78-122Chazova I.E., Martynyuk T.V., Valieva Z.S., et al. Eurasian clinical guidelines on diagnosis and treatment of pulmonary hypertension. Eurasian heart journal. 2020;(1):78-122. (In Russ.) https://doi.org/10.38109/2225-1685-2020-1-78-122Humbert М, Kovacs G, Hoeper M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal. 2022;43:3618-3731. https://doi.org/10.1183/13993003.00879-2022Humbert М, Kovacs G, Hoeper M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal. 2022;43:3618-3731. https://doi.org/10.1183/13993003.00879-2022The Seventh World Symposium on Pulmonary Hypertension: a collection of articles comprising the Proceedings of the Seventh World Symposium on Pulmonary Hypertension. European Respiratory Journal. 2024;URL https://publications.ersnet.org/content/erj (date of access: 23.06.2025).The Seventh World Symposium on Pulmonary Hypertension: a collection of articles comprising the Proceedings of the Seventh World Symposium on Pulmonary Hypertension. European Respiratory Journal. 2024;URL https://publications.ersnet.org/content/erj (date of access: 23.06.2025).Rich S, Dantzker DR, Ayres SM, et al. Primary pulmonary hypertension. A national prospective study. Annals of Internal Medicine. 1987;107(2):216-223. https://doi.org/10.7326/0003-4819-107-2-216Rich S, Dantzker DR, Ayres SM, et al. Primary pulmonary hypertension. A national prospective study. Annals of Internal Medicine. 1987;107(2):216-223. https://doi.org/10.7326/0003-4819-107-2-216Шария АМ, Мартынюк ТВ. Клиническое течение и прогноз у пациентов с идиопатической легочной артериальной гипертензией по данным современных регистров. Кардиологический вестник. 2021;16(3):23-27. https://doi.org/10.17116/Cardiobulletin20211603123Shariya AM, Martynyuk TV. Data of modern registries on clinical course and prognosis of patients with idiopathic pulmonary arterial hypertension. Russian Cardiology Bulletin. 2021;16(3):23 27. (In Russ.) https://doi.org/10.17116/Cardiobulletin20211603123Humbert M, Sitbon O, Yaïci A, et al. French pulmonary arterial hypertension network. Survival in incident and prevalent cohorts of patients with pulmonary arterial hypertension. European Respiratory Journal. 2010;36(3):549-555. https://doi.org/10.1183/09031936.00057010Humbert M, Sitbon O, Yaïci A, et al. French pulmonary arterial hypertension network. Survival in incident and prevalent cohorts of patients with pulmonary arterial hypertension. European Respiratory Journal. 2010;36(3):549-555. https://doi.org/10.1183/09031936.00057010Benza RL, Miller DP, Barst RJ, et al. An evaluation of long-term survival from time of diagnosis in pulmonary arterial hypertension from the REVEAL registry. Chest. 2012;142(2):448-456. https://doi.org/10.1378/chest.11-1460Benza RL, Miller DP, Barst RJ, et al. An evaluation of long-term survival from time of diagnosis in pulmonary arterial hypertension from the REVEAL registry. Chest. 2012;142(2):448-456. https://doi.org/10.1378/chest.11-1460Rådegran G, Kjellström B, Ekmehag B, et al. Characteristics and survival of adult Swedish PAH and CTEPH patients 2000-2014. Scand Cardiovasc J.2016;50(4):243-250. https://doi.org/10.1080/14017431.2016.1185532Rådegran G, Kjellström B, Ekmehag B, et al. Characteristics and survival of adult Swedish PAH and CTEPH patients 2000-2014. Scand Cardiovasc J.2016;50(4):243-250. https://doi.org/10.1080/14017431.2016.1185532Hoeper MM, Pausch C, Grünig E, et al. Idiopathic pulmonary arterial hypertension phenotypes determined by cluster analysis from the COMPERA registry. The Journal of Heart and Lung Transplantation. 2020;39(12):1435-1444. https://doi.org/10.1016/j.healun.2020.09.011Hoeper MM, Pausch C, Grünig E, et al. Idiopathic pulmonary arterial hypertension phenotypes determined by cluster analysis from the COMPERA registry. The Journal of Heart and Lung Transplantation. 2020;39(12):1435-1444. https://doi.org/10.1016/j.healun.2020.09.011Авдеев СН, Барбараш ОЛ, Валиева ЗС и др. Легочная гипертензия, в том числе хроническая тромбоэмболическая легочная гипертензия. Клинические рекомендации 2024. Российский кардиологический журнал. 2024;29(11):170–250. https://doi.org/10.15829/1560-4071-2024-6161Avdeev S.N., Barbarash O.L., Valieva Z.S., et al. 2024 Clinical practice guidelines for Pulmonary hypertension, including chronic thromboembolic pulmonary hypertension. Russian Journal of Cardiology. 2024;29(11): 170-250. (In Russ.) https://doi.org/10.15829/1560-4071-2024-6161Barst RJ, Chung L, Zamanian RT, et al. Functional class improvement and 3-year survival outcomes in patients with pulmonary arterial hypertension in the REVEAL Registry. Chest. 2013;144(1):160-168. https://doi.org/10.1378/chest.12-2417Barst RJ, Chung L, Zamanian RT, et al. Functional class improvement and 3-year survival outcomes in patients with pulmonary arterial hypertension in the REVEAL Registry. Chest. 2013;144(1):160-168. https://doi.org/10.1378/chest.12-2417Savarese G, Paolillo S, Costanzo P, et al. Do changes of 6-minute walk distance predict clinical events in patients with pulmonary arterial hypertension? A meta-analysis of 22 randomized trials. J Am Coll Cardiol. 2012;60(13):1192–1201.Savarese G, Paolillo S, Costanzo P, et al. Do changes of 6-minute walk distance predict clinical events in patients with pulmonary arterial hypertension? A meta-analysis of 22 randomized trials. J Am Coll Cardiol. 2012;60(13):1192–1201.Легочная гипертензия/ под ред. И. Е. Чазовой, Т.В. Мартынюк. – М: Практика, 2015. – 928 с. ISBN 978-5-89816-138-5Pulmonary hypertension/ edited by I.E. Chazova, T.V. Martynyuk. – M: Praktika, 2015. – 928 p. (In Russ.) ISBN 978-5-89816-138-5]Warwick G, Thomas PS, Yates DH. Biomarkers in pulmonary hypertension. Eur Respir J. 2018;32:503-512. https://doi.org/10.1183/09031936.00160307Warwick G, Thomas PS, Yates DH. Biomarkers in pulmonary hypertension. Eur Respir J. 2018;32:503-512. https://doi.org/10.1183/09031936.00160307Tello K, Axmann J, Ghofrani HA, et al. Relevance of the TAPSE/PASP ratio in pulmonary arterial hypertension. Int J Cardiol. 2018;266:229-235. https://doi.org/10.1016/j.ijcard.2018.01.053Tello K, Axmann J, Ghofrani HA, et al. Relevance of the TAPSE/PASP ratio in pulmonary arterial hypertension. Int J Cardiol. 2018;266:229-235. https://doi.org/10.1016/j.ijcard.2018.01.053van der Bruggen CE, Handoko ML, Bogaard HJ, et al. The Value of Hemodynamic Measurements or Cardiac MRI in the Follow-up of Patients With Idiopathic Pulmonary Arterial Hypertension. Chest. 2021 Apr;159(4):1575-1585. https://doi.org/10.1016/j.chest.2020.10.077van der Bruggen CE, Handoko ML, Bogaard HJ, et al. The Value of Hemodynamic Measurements or Cardiac MRI in the Follow-up of Patients With Idiopathic Pulmonary Arterial Hypertension. Chest. 2021 Apr;159(4):1575-1585. https://doi.org/10.1016/j.chest.2020.10.077Kylhammar 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(47):4175-4181. https://doi.org/10.1093/eurheartj/ehx257Kylhammar 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(47):4175-4181. https://doi.org/10.1093/eurheartj/ehx257Benza RL, Kanwar MK, Raina A, et al. 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. Chest. 2021;159(1):337-346. https://doi.org/10.1016/j.chest.2020.08.2069Benza RL, Kanwar MK, Raina A, et al. 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. Chest. 2021;159(1):337-346. https://doi.org/10.1016/j.chest.2020.08.2069PAH Risk Score Calculators: [site]. – [United Therapeutics Corporation], 2024. – URL: https://www.pahinitiative.com/hcp/risk-assessment/calculators (date of access: 30.08.2024).PAH Risk Score Calculators: [site]. – [United Therapeutics Corporation], 2024. – URL: https://www.pahinitiative.com/hcp/risk-assessment/calculators (date of access: 30.08.2024).Benza RL, Gomberg Maitland MI, Elliott CG, 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(2):323-337. https://doi.org/10.1016/j.chest.2019.02.004Benza RL, Gomberg Maitland MI, Elliott CG, 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(2):323-337. https://doi.org/10.1016/j.chest.2019.02.004Raina A, Humbert M. Risk assessment in pulmonary arterial hypertension. Eur Respir Rev.2016;25(142):390-398. https://doi.org/10.1183/16000617.0077-2016Raina A, Humbert M. Risk assessment in pulmonary arterial hypertension. Eur Respir Rev.2016;25(142):390-398. https://doi.org/10.1183/16000617.0077-2016Simons J.E. Mann D, Pierozynski A. Assessment of risk of disease progression in pulmonary arterial hypertension: insights from an international survey of clinical practice. Adv Ther. 2019;36(9):2351-2363. https://doi.org/10.1007/s12325-019-01030-4Simons J.E. Mann D, Pierozynski A. Assessment of risk of disease progression in pulmonary arterial hypertension: insights from an international survey of clinical practice. Adv Ther. 2019;36(9):2351-2363. https://doi.org/10.1007/s12325-019-01030-4Boucly A, Weatherald J, Humbert M, Sitbon O. Risk assessment in pulmonary arterial hypertension. Eur Respir J. 2018;51(3):1800279. https://doi.org/10.1183/13993003.00279-2018Boucly A, Weatherald J, Humbert M, Sitbon O. Risk assessment in pulmonary arterial hypertension. Eur Respir J. 2018;51(3):1800279. https://doi.org/10.1183/13993003.00279-2018Hoeper MM, Pausch C, Olsson KM, et al. COMPERA 2.0: a refined 4-strata risk assessment model for pulmonary arterial hypertension. Eur Respir J. 2022;60(1): 2102311. https://doi.org/10.1183/13993003.02311-2021Hoeper MM, Pausch C, Olsson KM, et al. COMPERA 2.0: a refined 4-strata risk assessment model for pulmonary arterial hypertension. Eur Respir J. 2022;60(1): 2102311. https://doi.org/10.1183/13993003.02311-2021Boucly A, Weatherald J, Savale L, et al. External validation of a refined 4-strata risk assessment score from the French pulmonary hypertension registry. Eur Respir J. 2022;59(6):2102419. https://doi.org/10.1183/13993003.02419-2021Boucly A, Weatherald J, Savale L, et al. External validation of a refined 4-strata risk assessment score from the French pulmonary hypertension registry. Eur Respir J. 2022;59(6):2102419. https://doi.org/10.1183/13993003.02419-2021

The authors declare that there are no conflicts of interest present.