The Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) score originally used decimal fractions to generate a score. This was modified to use integers. The authors are from multiple institutions in the United States and participated in the REVEAL trial.
Patient selection: pulmonary arterial hypertension (PAH)
Parameters:
(1) WHO group
(2) demographics (age, gender, renal function)
(3) WHO functional class (NYHA)
(4) systolic blood pressure in mm Hg (vital signs)
(5) heart rate in beats per minute (vital signs)
(6) 6-minute walking distance in meters
(7) BNP in pg/mL
(8) pericardial effusion
(9) diffusion capacity of carbon monoxide (DLco) as percent of predicted
(10) right heart catheterization (right atrial pressure in mm Hg, pulmonary vascular resistance in Wood units)
|
Parameters |
Findings |
Points |
|
WHO group |
connective tissue disease |
1 |
|
|
portal hypertension |
2 |
|
|
other |
0 |
|
demographic |
male and > 60 years of age |
2 |
|
|
renal dysfunction |
1 |
|
|
other |
0 |
|
WHO/NYHA functional class |
I |
-2 |
|
|
II |
0 |
|
|
III |
1 |
|
|
IV |
2 |
|
systolic blood pressure |
> 109 mmm Hg |
0 |
|
|
<= 109 mm Hg |
1 |
|
heart rate |
<= 92 beats per minute |
0 |
|
|
> 92 beats per minute |
1 |
|
6 minute walking distance |
< 165 meters |
1 |
|
|
165 to 439.9 meters |
0 |
|
|
>= 440 meters |
-1 |
|
BNP |
< 50 pg/mL |
-2 |
|
|
50 to 179 pg/mL |
0 |
|
|
>= 180 pg/mL |
1 |
|
pericardial effusion |
no |
0 |
|
|
yes |
1 |
|
DLco |
>= 80% of predicted |
-1 |
|
|
33 to 79% |
0 |
|
|
< 33% |
1 |
|
right heart catheterization |
pulmonary vascular resistance > 32 Wood units |
2 |
|
|
RAP > 20 mm Hg |
1 |
|
|
other |
0 |
where:
• It is unclear if demographics (#2), vital signs (#4 and 5) and right heart catheterization (#10) involve one or two scored items.
total score =
= SUM(points for all of the parameters) + 6
Interpretation:
• minimum score: 0 (the addition of 6 points avoids a negative score)
• maximum score: 20 (as given; up to 22 if all items separate)
• A score >= 8 was associated with a worse prognosis.
|
Score |
5-Year Survival |
|
1 to 4 |
82% |
|
5 or 6 |
57% |
|
7 or 8 |
38% |
|
9 |
25% |
|
>= 10 |
14% |
Performance:
• The are uner the REVEAL score was 0.71.
Specialty: Pulmonology, Cardiology
