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the recommendation provided and the quality of evidence supporting the recommendation. The Task Force discussed each draft recommendation during web-based conference calls dedicated to specific sections, followed by consensus modifications and an online vote on each recommendation. Only recommendations that were supported by at least 75% of the Task Force members were included in the guidelines. The recommendation tables were colour-coded for ease of interpretation. 3 Definitions and classifications 3.1 Definitions The definitions for PH are based on haemodynamic assessment by right heart catheterization (RHC). Although haemodynamics represent the central element of characterizing PH, the final diagnosis and classification should reflect the whole clinical context and consider the results of all investigations. Table 3 Classes of recommendations ©ESC/ERS 2022 Classes of recommendations Class I Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective. efficacy of the given treatment or procedure. favour of usefulness/efficacy. Usefulness/efficacy is less well useful/effective, and in some cases Conflicting evidence and/or a divergence of opinion about the usefulness/ Is recommended or is indicated Wording to use Definition Class III Evidence or general agreement that the given treatment or procedure is not may be harmful. Is not recommended Class IIb established by evidence/opinion. May be considered Class IIa Weight of evidence/opinion is in Should be considered Class II © ESC/ERS 2022 Table 4 Levels of evidence Level of evidence A Level of evidence B Level of evidence C Data derived from multiple randomized clinical trials or meta-analyses. Data derived from a single randomized clinical trial or large non-randomized studies. Consensus of opinion of the experts and/or small studies, retrospective studies, registries. ©ESC/ERS 2022 © ESC/ERS 2022 Downloaded from academic.oup.com/eurheartj/article/43/38/3618/6673929 by guest on 07 October 2026