Definitions and Diagnosis of Pulmonary Hypertension

Abstract

Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure ≥ 25 mm Hg at rest, measured during right heart catheterization. There is still insufficient evidence to add an exercise criterion to this definition. The term pulmonary arterial hypertension (PAH) describes a subpopulation of patients with PH characterized hemodynamically by the presence of pre-capillary PH including an end-expiratory pulmonary artery wedge pressure (PAWP) ≤ 15 mm Hg and a pulmonary vascular resistance >3 Wood units. Right heart catheterization remains essential for a diagnosis of PH or PAH. This procedure requires further standardization, including uniformity of the pressure transducer zero level at the midthoracic line, which is at the level of the left atrium. One of the most common problems in the diagnostic workup of patients with PH is the distinction between PAH and PH due to left heart failure with preserved ejection fraction (HFpEF). A normal PAWP does not rule out the presence of HFpEF. Volume or exercise challenge during right heart catheterization may be useful to unmask the presence of left heart disease, but both tools require further evaluation before their use in general practice can be recommended. Early diagnosis of PAH remains difficult, and screening programs in asymptomatic patients are feasible only in high-risk populations, particularly in patients with systemic sclerosis, for whom recent data suggest that a combination of clinical assessment and pulmonary function testing including diffusion capacity for carbon monoxide, biomarkers, and echocardiography has a higher predictive value than echocardiography alone.

Risk of Echocardiographic Pulmonary Hypertension in Individuals with Human Immunodeficiency Virus–Hepatitis C Virus Coinfection

“…Although echocardiogram is a reasonable noninvasive method of screening for PH, a proportion of our study sample was not included in the final analysis due to either poor acoustic windows or an inadequate tricuspid regurgitant jet to estimate PASP, thus limiting our power and potentially resulting in misclassification of outcome (39). Only two of the patients in the cohort (both of whom were classified as having PH/RV dysfunction) had right heart catheterization performed, confirming pulmonary arterial hypertension (40). Although an echocardiogram-based approach is reasonable as a first step in studying novel risk factors for pulmonary vascular disease, large prospective studies with invasive hemodynamics would be optimal going forward.…”

Subclinical Atherosclerosis in Systemic Sclerosis: Not Less Frequent Than Rheumatoid Arthritis and Not Detected With Cardiovascular Risk Indices

“…All SSc patients with clinical, echocardiographic, or PFT suspicion of PAH underwent right-sided heart catheterization. Patients with a mean pulmonary artery pressure $25 mm Hg at rest and an end-expiratory pulmonary artery wedge pressure #15 mm Hg, and a pulmonary vascular resistance .3 Wood units were defined as having PAH (27). Esophageal involvement was defined as any sign of dysmotility evident on endoscopy, esophagography, or manometry.…”

Impact of bosentan therapy on stress-induced pulmonary hypertension in patients with scleroderma systematica

“…В нашем исследовании критерии включения/исклю-чения соответствовали дифференциально-диагностиче-скому алгоритму ЛГ [6], в связи с чем вероятность раз-вития других вариантов ЛГ в данной группе, гипоксеми-ческой, обусловленной поражением левых отделов серд-ца и легочными тромбоэмболиями -гипотетически ис-ключена. Мы предполагаем, что исходный отбор паци-ентов по этим признакам позволяет выделить группу пациентов, предрасположенных к развитию ЛАГ, с СИ-ЛГ, возможно, являющейся ее доклинической стадией.…”

“…Кроме того, неяс-ны прогностическое значение и терапевтическая обосно-ванность СИ-ЛГ. Поэтому до настоящего времени термин СИ-ЛГ не внедрен в повседневную практику, согласно последним рекомендациям 5-го Симпозиума по ЛГ в Ницце эта дефиниция требует уточнения [6].…”