Updated Clinical Classification and Hemodynamic Definitions of Pulmonary Hypertension and Its Clinical Implications

被引:8
作者
Kularatne, Mithum [1 ]
Gerges, Christian [2 ]
Jevnikar, Mitja [3 ,4 ,5 ]
Humbert, Marc [3 ,4 ,5 ]
Montani, David [3 ,4 ,5 ]
机构
[1] Univ Calgary, Dept Med, Div Resp Med, Calgary, AB T2N 1N4, Canada
[2] Med Univ Vienna, Dept Internal Med 2, Div Cardiol, A-1090 Vienna, Austria
[3] Hop Bicetre, Assistance Publ Hop Paris AP HP, Pulm Hypertens Natl Referral Ctr, Dept Resp & Intens Care Med,DMU 5 Thorinno, F-94270 Le Kremlin Bicetre, France
[4] Univ Paris Saclay, Sch Med, F-94270 Le Kremlin Bicetre, France
[5] Hop Marie Lannelongue, Pulm Hypertens Pathophysiol & Novel Therapies, INSERM UMR S 999, F-92350 Le Plessis Robinson, France
关键词
pulmonary hypertension; right heart catheterization; pulmonary vascular disease; CALCIUM-CHANNEL BLOCKERS; ARTERIAL-HYPERTENSION; SYSTEMIC-SCLEROSIS; PROGNOSTIC VALUE; WORLD SYMPOSIUM; EXERCISE; PRESSURE; DIAGNOSIS; SURVIVAL; OUTCOMES;
D O I
10.3390/jcdd11030078
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Pulmonary hypertension (PH) refers to a pathologic elevation of the mean pulmonary artery pressure (mPAP) and is associated with increased morbidity and mortality in a wide range of medical conditions. These conditions are classified according to similarities in pathophysiology and management in addition to their invasive hemodynamic profiles. The 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension present the newest clinical classification system and includes significant updates to the hemodynamic definitions. Pulmonary hypertension is now hemodynamically defined as an mPAP > 20 mmHg, reduced from the previous threshold of >= 25 mmHg, due to important insights from both normative and prognostic data. Pulmonary vascular resistance has been extended into the definition of pre-capillary pulmonary hypertension, with an updated threshold of >2 Wood Units (WU), to help differentiate pulmonary vascular disease from other causes of increased mPAP. Exercise pulmonary hypertension has been reintroduced into the hemodynamic definitions and is defined by an mPAP/cardiac output slope of >3 mmHg/L/min between rest and exercise. While these new hemodynamic thresholds will have a significant impact on the diagnosis of pulmonary hypertension, no evidence-based treatments are available for patients with mPAP between 21-24 mmHg and/or PVR between 2-3 WU or with exercise PH. This review highlights the evidence underlying these major changes and their implications on the diagnosis and management of patients with pulmonary hypertension.
引用
收藏
页数:12
相关论文
共 59 条
[31]   The 4th World Symposium on Pulmonary Hypertension INTRODUCTION [J].
Humbert, Marc ;
McLaughlin, Vallerie V. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 54 (01) :S1-S2
[32]   Predictors of outcomes in mild pulmonary hypertension according to 2022 ESC/ERS Guidelines: the EVIDENCE-PAH UK study [J].
Karia, Nina ;
Howard, Luke ;
Johnson, Martin ;
Kiely, David G. ;
Lordan, James ;
McCabe, Colm ;
Pepke-Zaba, Joanna ;
Ong, Rose ;
Preiss, Michael ;
Knight, Daniel ;
Muthurangu, Vivek ;
Coghlan, J. Gerry .
EUROPEAN HEART JOURNAL, 2023, 44 (44) :4678-4691
[33]   Pulmonary vascular resistances during exercise in normal subjects: a systematic review [J].
Kovacs, G. ;
Olschewski, A. ;
Berghold, A. ;
Olschewski, H. .
EUROPEAN RESPIRATORY JOURNAL, 2012, 39 (02) :319-328
[34]   Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review [J].
Kovacs, G. ;
Berghold, A. ;
Scheidl, S. ;
Olschewski, H. .
EUROPEAN RESPIRATORY JOURNAL, 2009, 34 (04) :888-894
[35]   An official European Respiratory Society statement: pulmonary haemodynamics during exercise [J].
Kovacs, Gabor ;
Herve, Philippe ;
Barbera, Joan Albert ;
Chaouat, Ari ;
Chemla, Denis ;
Condliffe, Robin ;
Garcia, Gilles ;
Grunig, Ekkehard ;
Howard, Luke ;
Humbert, Marc ;
Lau, Edmund ;
Laveneziana, Pierantonio ;
Lewis, Gregory D. ;
Naeije, Robert ;
Peacock, Andrew ;
Rosenkranz, Stephan ;
Saggar, Rajeev ;
Ulrich, Silvia ;
Vizza, Dario ;
Noordegraaf, Anton Vonk ;
Olschewski, Horst .
EUROPEAN RESPIRATORY JOURNAL, 2017, 50 (05)
[36]   Evidence of Advanced Pulmonary Vascular Remodeling in Obstructive Hypertrophic Cardiomyopathy With Pulmonary Hypertension [J].
Maron, Bradley A. ;
Kleiner, David E. ;
Arons, Elena ;
Wertheim, Bradley M. ;
Sharma, Nirmal S. ;
Haley, Kathleen J. ;
Samokhin, Andriy O. ;
Rowin, Ethan J. ;
Maron, Martin S. ;
Rosing, Douglas R. ;
Maron, Barry J. .
CHEST, 2023, 163 (03) :678-686
[37]   Pulmonary vascular resistance and clinical outcomes in patients with pulmonary hypertension: a retrospective cohort study [J].
Maron, Bradley A. ;
Brittan, Evan L. ;
Hess, Edward ;
Waldo, Stephen W. ;
Baron, Anna E. ;
Huang, Shi ;
Goldstein, Ronald H. ;
Assad, Tufik ;
Wertheim, Bradley M. ;
Alba, George A. ;
Leopold, Jane A. ;
Olschewski, Horst ;
Galie, Nazzareno ;
Simonneau, Gerald ;
Kovacs, Gabor ;
Tedford, Ryan J. ;
Humbert, Marc ;
Choudhary, Gaurav .
LANCET RESPIRATORY MEDICINE, 2020, 8 (09) :873-884
[38]   A Concerning Trend for Patients With Pulmonary Hypertension in the Era of Evidence-Based Medicine [J].
Maron, Bradley A. ;
Ryan, John J. .
CIRCULATION, 2019, 139 (16) :1861-1864
[39]   F Redefining pulmonary hypertension [J].
Maron, Bradley A. ;
Brittain, Evan L. ;
Choudhary, Gaurav ;
Gladwin, Mark T. .
LANCET RESPIRATORY MEDICINE, 2018, 6 (03) :168-170
[40]   Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program [J].
Maron, Bradley A. ;
Hess, Edward ;
Maddox, Thomas M. ;
Opotowsky, Alexander R. ;
Tedford, Ryan J. ;
Lahm, Tim ;
Joynt, Karen E. ;
Kass, Daniel J. ;
Stephens, Thomas ;
Stanislawski, Maggie A. ;
Swenson, Erik R. ;
Goldstein, Ronald H. ;
Leopold, Jane A. ;
Zamanian, Roham T. ;
Elwing, Jean M. ;
Plomondon, Mary E. ;
Grunwald, Gary K. ;
Baron, Anna E. ;
Rumsfeld, John S. ;
Choudhary, Gaurav .
CIRCULATION, 2016, 133 (13) :1240-1248