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• BNP
  Increase of NT-ProBNP levels (or BNP if NT-ProBNP not available) during follow-up is associated with worse prognosis. Measurement of the NT-ProBNP is recommended for initial risk stratification and it can be considered for monitoring the effect of treatment. However decision making should not be done on NT-ProBNP alone. It should be emphasized that NT-ProBNP is elevated in both right or left heart failure and therefore is not specific for PH worsening.
  
  
• Other markers
  Uric acid and Troponin, as well as other biomarkers need further investigation in patients with PAH and are not recommended for routine clinical practice.
  
  

Better prognosis	Determinants of prognosis	Worse prognosis
No	Clinical evidence of RV failure	Yes
Slow	Rate of progression of symptoms	Rapid
No	Syncope	Yes
I, II	WHO-FC	IV
Longer (>500m)a	6MWT	Shorter (<300m)
Peak O₂ consumption > 15 mL/min/kg	Cardio-pulmonary exercise testing	Peak O₂ consumption < 12 mL/min/kg
Normal or near-normal	BNP/NT-proBNP plasma levels	Very elevated and rising
No pericardial effusion TAPSEb > 2.0 cm	Echocardiographic findingsb	Pericardial effusion TAPSEb < 1.5 cm
RAP < 8 mmHg and CI ≥ 2.5 L/min/m²	Haemodynamics	RAP > 15mmHg or CI ≤ 2.0 L/min/m²

 
^a depending on age

^b TAPSE and pericardial effusion have been selected because they can be measured in the majority of the patients

BNP	brain natriuretic peptide
CI	cardiac index
6MWT	6-minute walking test
RAP	right atrial pressure
TAPSE	tricuspid annular plance systolic excursion
WHO-FC	WHO functional class