How is PAH severity classified?
Once diagnosed, Pulmonary arterial hypertension (PAH) is usually classified according to a functional class system initially devised by the New York Heart Association (NYHA) for Chronic Heart Failure and then adapted for Pulmonary Arterial Hypertension (PAH) by the World Health Organization (WHO). This functional class measures the severity of Pulmonary Arterial Hypertension (PAH) and reflects the impact on a patient's life in terms of physical activity and symptoms. There are four classes, with class I being the least severe and class IV being the most advanced (Table 1).1
Table 1. NYHA/WHO Classification of Functional Status of Patients With Pulmonary Hypertension1
| Class |
Symptomatic profile |
| Class I |
Patients with pulmonary hypertension but without resulting limitation of physical activity. Ordinary physical activity does not cause Dyspnoea or fatigue, chest pain or near syncope |
| Class II |
Patients with pulmonary hypertension resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity causes undue dyspnoea or fatigue, chest pain or near syncope |
| Class III |
Patients with pulmonary hypertension resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes undue dyspnoea or fatigue, chest pain or near syncope |
| Class IV |
Patients with pulmonary hypertension with inability to carry out any physical activity without symptoms. These patients manifest signs of right heart failure. Dyspnoea and/or fatigue may even be present at rest. Discomfort is increased by any physical activity. |
References
1. Barst RJ, McGoon M, Torbicki A et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2004;43 (Suppl S) :40S-47S.
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Last Updated: 17-Jul-07.
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