Reveal 2 0 score | cardiovascular Calculator

REVEAL 2.0 Clinical Assessment

Validated for WHO Group 1 PAH. Goal-directed therapy targets a Low Risk (≤6) status.

Etiology & History

PAH Etiology (Mutually Exclusive)

REVEAL Lite Zone

Clinical & Functional

NYHA/WHO Functional Class

SBP: 120 mmHg0

Heart Rate: 80 bpm0

6-Minute Walk (m)

BNP (pg/mL)

Invasive & Diagnostics

DLCO % Predicted

Mean RAP (mmHg)

PVR (Wood units)

Ready for Assessment

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Primary Clinical Uses

Predict 1-year and 5-year mortality risk in patients with Pulmonary Arterial Hypertension (PAH)

Guide treatment escalation decisions with goal of achieving or maintaining low-risk status

Monitor treatment response at follow-up assessments (recommended every 3-6 months)

Risk stratify patients with inoperable or persistent/recurrent CTEPH (post hoc validation)

Key Clinical Context

The REVEAL 2.0 score demonstrates greater risk discrimination (c-statistic 0.73-0.76) than COMPERA (0.62) or French registry (0.64) strategies. However, in patients with PH secondary to left heart disease (WHO Group 2), the score accurately predicts high-risk outcomes but may not differentiate intermediate from low risk.

Section 2

Formula & Logic

Scoring Formula (REVEAL 2.0 — 13 Variables)

Total Score = 6 + Σ(point values from all applicable variables) PAH Etiology: • Connective tissue disease (CTD-PAH): +1 • Portopulmonary hypertension (PoPH): +3 • Heritable PAH (HPAH): +2 Demographics: • Male >60 years: +2 Renal Function: • eGFR <60 mL/min/1.73m²: +1 NYHA/WHO Functional Class: • FC I: −1 • FC III: +1 • FC IV: +2 Hospitalization (within 6 months): +1 Vital Signs: • Systolic BP <110 mmHg: +1 • Heart rate >96 bpm: +1 6-Minute Walk Distance: • ≥440 m: −2 • 320–439 m: −1 • <165 m: +1 BNP/NT‑proBNP: • BNP <50 pg/mL OR NT‑proBNP <300 pg/mL: −2 • BNP 200–799 pg/mL: +1 • BNP ≥800 pg/mL OR NT‑proBNP ≥1100 pg/mL: +2 Echocardiogram: • Pericardial effusion: +1 Pulmonary Function Test: • DLCO <40% predicted: +1 Hemodynamics (RHC within 1 year): • Mean RAP >20 mmHg: +1 • PVR <5 Wood units: −1

Risk Stratification (Three‑Category Model)

Risk Category	Score Range	1‑Year Mortality	Hazard Ratio (95% CI)
Low Risk	≤6	1.9% (1.1-2.7)	Reference
Intermediate Risk	7–8	6.5% (4.7-8.4)	2.73 (2.2-3.4)
High Risk	≥9	25.8% (22.7-28.9)	8.09 (6.6-9.9)

REVEAL Lite 2 — Abridged Version (6 Noninvasive Variables)

Risk Category	Score Range	1‑Year Mortality	Variables
Low Risk	≤5	2.9% (1.8-3.9)	NYHA/WHO FC, SBP, HR, 6MWD, BNP/NT‑proBNP, eGFR
Intermediate Risk	6–7	7.1% (5.4-8.8)	All noninvasive, modifiable
High Risk	≥8	25.1% (21.9-28.4)	No invasive hemodynamics required

Section 3

Pearls/Pitfalls

Critical Implementation Notes

Minimum 7 variables required for valid REVEAL 2.0 score calculation

Use notation "r" for imaging-based or "p" for pathology-based findings when available

REVEAL Lite 2 is preferred for routine clinical follow-up (no RHC required)

In WHO Group 2 PH (PH-LHD), the score predicts high-risk outcomes but intermediate risk may be overestimated (Sharp-Dimitri et al., 2024)

The TAPSE/sPAP ratio (0.35 mm/mmHg cutoff) improves risk discrimination for scores between 5–8

Performance Metrics

C‑statistic (3‑category): 0.73 (95% CI 0.71-0.75)

C‑statistic (original 8‑tier): 0.76 (95% CI 0.74-0.78)

External validation (PHSANZ Registry): C‑statistic 0.74

REVEAL Lite 2 C‑statistic: 0.70 (95% CI 0.68-0.72)

Section 4

Next Steps

Treatment Implications (ESC/ERS Guidelines)

Low Risk (score ≤6): Continue current therapy; reassess every 6–12 months

Intermediate Risk (score 7–8): Consider treatment escalation; reassess every 3–6 months

High Risk (score ≥9): Escalate therapy (consider parenteral prostacyclin); refer to expert center

REVEAL Lite 2 can be used for more frequent noninvasive monitoring

Special Populations

In CTEPH patients (CHEST study), a 1-point improvement in REVEAL 2.0 was associated with 27% reduction in relative risk of death. In PH-LHD, high-risk patients (score ≥9) had 11-fold increased mortality risk at 3 years (HR 11.10, 95% CI 1.50-81.9).

Section 5

Evidence Appraisal

Primary Sources

Predicting Survival in Patients With Pulmonary Arterial Hypertension: The REVEAL Risk Score Calculator 2.0 and Comparison With ESC/ERS-Based Risk Assessment Strategies

Benza RL et al. • Chest. 2019;Original derivation and validation of REVEAL 2.0 in 2,529 PAH patients. C-statistic 0.76 for 8-tier model, 0.73 for 3-category model.

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

Benza RL et al. • Chest. 2021;Simplified 6-variable noninvasive score. C-statistic 0.70, maintains good discrimination without RHC.

Mortality Risk Assessment Using the REVEAL 2.0 Score in Pulmonary Hypertension Secondary to Left Heart Disease

Sharp-Dimitri D et al. • Research Square. 2024;First validation of REVEAL 2.0 in WHO Group 2 PH. High-risk patients (≥9) had HR 11.10 for 3-year mortality.

Application of the REVEAL risk score calculator 2.0 in the CHEST study

Benza RL et al. • Respiratory Medicine. 2022;Validation in CTEPH patients receiving riociguat. 1-point improvement associated with 27% risk reduction.

Section 6

Literature

REVEAL Registry

The Registry to Evaluate Early and Long‑Term PAH Disease Management (REVEAL) is a multicenter, US‑based observational registry that enrolled 3,515 patients with pulmonary arterial hypertension between 2006 and 2009. The REVEAL 2.0 risk score was published in 2019 as an update to the original 2010 REVEAL risk calculator, incorporating new variables (eGFR, hospitalization within 6 months) and revised cut points to improve risk discrimination.

Last Comprehensive Review: 2026

Risk Category

Score Range

1‑Year Mortality

Hazard Ratio (95% CI)

Low Risk

≤6

1.9% (1.1-2.7)

Reference

Intermediate Risk

7–8

6.5% (4.7-8.4)

2.73 (2.2-3.4)

High Risk

≥9

25.8% (22.7-28.9)

8.09 (6.6-9.9)

Risk Category

Score Range

1‑Year Mortality

Variables

Low Risk

≤5

2.9% (1.8-3.9)

NYHA/WHO FC, SBP, HR, 6MWD, BNP/NT‑proBNP, eGFR

Intermediate Risk

6–7

7.1% (5.4-8.8)

All noninvasive, modifiable

High Risk

≥8

25.1% (21.9-28.4)

No invasive hemodynamics required

REVEAL 2.0 Score

Etiology & History

Clinical & Functional

Invasive & Diagnostics

Clinical Details

When to Use

Primary Clinical Uses

Key Clinical Context

Formula & Logic

Scoring Formula (REVEAL 2.0 — 13 Variables)

Risk Stratification (Three‑Category Model)

REVEAL Lite 2 — Abridged Version (6 Noninvasive Variables)

Pearls/Pitfalls

Critical Implementation Notes

Performance Metrics

Next Steps

Treatment Implications (ESC/ERS Guidelines)

Special Populations

Evidence Appraisal

Primary Sources

Predicting Survival in Patients With Pulmonary Arterial Hypertension: The REVEAL Risk Score Calculator 2.0 and Comparison With ESC/ERS-Based Risk Assessment Strategies

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

Mortality Risk Assessment Using the REVEAL 2.0 Score in Pulmonary Hypertension Secondary to Left Heart Disease

Application of the REVEAL risk score calculator 2.0 in the CHEST study

Literature

REVEAL Registry

Related Cardiovascular Tools

REVEAL 2.0 Score

Etiology & History

Clinical & Functional

Invasive & Diagnostics

Clinical Details

When to Use

Primary Clinical Uses

Key Clinical Context

Formula & Logic

Scoring Formula (REVEAL 2.0 — 13 Variables)

Risk Stratification (Three‑Category Model)

REVEAL Lite 2 — Abridged Version (6 Noninvasive Variables)

Pearls/Pitfalls

Critical Implementation Notes

Performance Metrics

Next Steps

Treatment Implications (ESC/ERS Guidelines)

Special Populations

Evidence Appraisal

Primary Sources

Predicting Survival in Patients With Pulmonary Arterial Hypertension: The REVEAL Risk Score Calculator 2.0 and Comparison With ESC/ERS-Based Risk Assessment Strategies

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

Mortality Risk Assessment Using the REVEAL 2.0 Score in Pulmonary Hypertension Secondary to Left Heart Disease

Application of the REVEAL risk score calculator 2.0 in the CHEST study

Literature

REVEAL Registry

Related Cardiovascular Tools