Prognostic Factors in Pulmonary Hypertension

Pulmonary hypertension (PH) is a progressive and heterogeneous disorder in which accurate prognostication is essential for risk stratification, treatment escalation, and transplant planning. This review summarizes established and emerging prognostic factors in pulmonary arterial hypertension, emphasizing clinical status, six-minute walk distance, World Health Organization functional class, invasive hemodynamics, natriuretic peptides, echocardiography, and cardiac magnetic resonance imaging. Particular attention is given to right ventricular adaptation, because right ventricular function and rightventriculo-pulmonary arterial coupling remain central determinants of outcomes. The review also discusses biomarkers reflecting myocardial stress, inflammation, angiogenesis, and tissue remodeling, including GDF-15, MR-proADM, IL-6, TNF-α, suPAR, angiopoietin-2, VEGF, periostin, and kallistatin. Contemporary risk models such as COMPERA 2.0, REVEAL 2.0, and REVEAL Lite 2 are reviewed as dynamic tools for longitudinal risk assessment. Integrating conventional parameters with imaging, biomarkers, and emerging proteomic approaches may improve individualized prognostication and support precision medicine in pulmonary hypertension.