Pulmonary hypertension associated with left heart disease: Updated Recommendations of the Cologne Consensus Conference 2018

Rosenkranz, Stephan; Lang, Irene; Blindt, Rüdiger; Bonderman, Diana; Bruch, Leonhard; Diller, Gerhard Paul; Felgendreher, Ralf; Gerges, Christian; Hohenforst-Schmidt, Wolfgang; Holt, Stephan; Jung, Christian; Kindermann, Ingrid; Kramer, Tilmann; Kübler, W.; Mitrović, Veselin; Riedel, Andreas; Rieth, Andreas; Schmeißer, Alexander; Wachter, Rolf; Weil, Joachim; Opitz, Christian

doi:10.1016/j.ijcard.2018.08.080

Cited by 55 publications

(45 citation statements)

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“…In case of significant lung disease causative of pulmonary vascular abnormalities, patients were excluded from the analysis. Differentiation of PAH with ("atypical PAH") and without comorbidities ("typical PAH") was defined according to the criteria from the Cologne consensus conference 2017 [18][19][20] and from the 6th PH-World Symposium 2018 [21,22]. Cardiac phenotype was defined as having at least three of the following conditions: systemic arterial hypertension, coronary artery disease, diabetes mellitus, obesity (BMI > 30 kg/m 2 ), left atrial enlargement or atrial fibrillation.…”

Section: Definition Of Pah and Comorbiditiesmentioning

confidence: 99%

Risk stratification and prognostic factors in patients with pulmonary arterial hypertension and comorbidities a cross-sectional cohort study with survival follow-up

et al. 2020

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Background: The objective of this study was to analyze prognostic factors and risk stratification in patients with pulmonary arterial hypertension (PAH) and comorbidities. Methods: Patients with invasively diagnosed PAH were included in the analysis. Comorbidities were clinically diagnosed as proposed in the 6th World Symposium of pulmonary hypertension. Uni-and multivariate analysis were employed for identification of factors predicting survival and time to first clinical worsening (TTCW). Risk stratification was based on parameters from ESC/ERS-guidelines 2015. Results: In total 142 patients were enrolled in the study, 90 of them were diagnosed as PAH without and 52 with comorbidities. All patients received targeted PAH therapy and were followed for 3.3 ± 2.4 years. In PAH patients without comorbidities survival and TTCW were significantly associated with reduced 6-min walking distance (6MWD), elevated N-terminal pro brain natriuretic peptide (NT-proBNP), WHO-functional class (WHO-FC) and right atrial (RA) area. In the multivariate analysis, 6MWD was an independent predictor for survival (p = 0.002) and WHO-FC for TTCW (p = 0.001). In patients with PAH and comorbidities these parameters had no significant association with survival and TTCW. Average risk score was significantly associated with survival (p = 0.001) and TTCW (p = 0.013) in PAH but not in PAH with comorbidities (both p > 0.05; figure 1).

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Section: Definition Of Pah and Comorbiditiesmentioning

confidence: 99%

Risk stratification and prognostic factors in patients with pulmonary arterial hypertension and comorbidities a cross-sectional cohort study with survival follow-up

et al. 2020

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“…LVEDP > 15 mmHg), welche primär durch eine Rückwärtsübertragung erhöhter links-kardialer Füllungsdrucke bedingt ist. Eine rein durch Rückstau in die pulmonale Zirkulation bedingte, meist milde ausgeprägte PH wird als isoliert post-kapilläre PH (IpcPH) bezeichnet [2,19,20]. Hierbei ist der PVR < 3 WE.…”

Section: Pulmonale Hypertonie Bei Linksherzerkrankungen (Nizza-gruppe 2)unclassified

“…Hierbei ist der PVR < 3 WE. Besteht jedoch zusätzlich eine Erhöhung des PVR auf ≥ 3 WE, so liegt eine kombiniert post-und prä-kapilläre PH (CpcPH) vor [2,[19][20][21]. Vorhandensein und Ausprägung einer PH haben für Patienten mit Linksherzerkrankung erhebliche prognostische Bedeutung.…”

Section: Pulmonale Hypertonie Bei Linksherzerkrankungen (Nizza-gruppe 2)unclassified

“…Insbesondere eine PVR-Erhöhung geht mit einer eingeschränkten Lebens erwartung einher [22]. Da die primäre Ursache der post-kapillären PH im linken Herzen liegt, ist das vorrangige Therapieziel eine optimierte Therapie der zugrunde liegenden Linksherzerkrankung unter Ausschöpfung medikamentöser, interventioneller und operativer Verfahren [2,19,20]. Hierzu gehört insbesondere auch eine konsequente Diuretikatherapie.…”

Section: Pulmonale Hypertonie Bei Linksherzerkrankungen (Nizza-gruppe 2)unclassified

“…Besteht jedoch trotz optimierter Therapie einer Linksherzerkrankung eine CpcPH, so kann eine zusätzlich bestehende pulmonal vaskuläre Erkrankung und somit ein therapeutisches Target angenommen werden. Obgleich kleinere Studien Hinweise auf einen therapeutischen Nutzen bei HFpEF und CpcPH zeigten [25,26] und ein Behandlungsversuch im Einzelfall sinnvoll sein kann [20], sind PAH-Medikamente in dieser Situation nicht zugelassen. Kontrollierte Studien sind notwendig.…”

Section: Pulmonale Hypertonie Bei Linksherzerkrankungen (Nizza-gruppe 2)unclassified

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Pulmonale Hypertonie: Update 2019

Rosenkranz

2019

Klinikarzt

Self Cite

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ZUSAMMENFASSUNGPulmonale Hypertonie (PH) ist ein hämodynamischer Zustand, der als gemeinsame Konsequenz einer Reihe von Erkrankungen entstehen kann, die aufgrund unterschiedlicher Pathomechanismen zu einer Erhöhung des pulmonal arteriellen Drucks und infolge dessen zu chronischer Rechtsherzbelastung führen. Je nach zugrunde liegender Ursache untergliedert die klinische Klassifikation die PH in 5 Gruppen: Pulmonal arterielle Hypertonie (Gruppe 1), PH in Zusammenhang mit Linksherzerkrankungen (Gruppe 2), PH bei chronischen Lungenerkrankungen (Gruppe 3), chronisch-thromboembolische PH (CTEPH; Gruppe 4) und PH aufgrund unklarer und/oder multifaktorieller Mechanismen (Gruppe 5). Dieser Artikel fokussiert auf die klinische Relevanz dieser Untergliederung und das unterschiedliche Management der verschiedenen PH-Formen. Er beleuchtet zudem kritisch neue Entwicklungen wie die modifizierte hämodynamische Definition der PH.

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Impact of the new pulmonary hypertension definition on long‐term mortality in patients with severe aortic stenosis undergoing valve replacement

Maeder

Weber

Weilenmann

et al. 2021

Clinical Cardiology

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Background The new 2018 pulmonary hypertension (PH) definition includes a lower mean pulmonary artery pressure (mPAP) cut‐off (>20 mmHg rather than ≥25 mmHg) and the compulsory requirement of a pulmonary vascular resistance (PVR) ≥3 Wood units (WU) to define precapillary PH. We assessed the clinical impact of the 2018 compared to the 2015 PH definition in aortic stenosis (AS) patients undergoing aortic valve replacement (AVR). Methods Severe AS patients (n = 487) undergoing pre‐AVR right heart catheterization were classified according to the 2015 and 2018 definitions. Post‐AVR mortality (median follow‐up 44 months) was assessed. Results Based on the 2015 definition, 66 (13%) patients exhibited combined pre and postcapillary PH (CpcPH), 116 (24%) isolated post‐capillary PH (IpcPH), 28 (6%) precapillary PH, and 277 (57%) no PH at all. Overall, 52 (11%) patients were reclassified: 23 no PH into IpcPH; 8 no PH into precapillary PH; 20 precapillary PH into no PH; 1 CpcPH into IpcPH. By the 2015 definition, only CpcPH patients displayed increased mortality, whereas by the 2018 definition, precapillary PH patients also experienced higher mortality than those without PH. Among the PH definition components, PVR ≥3 WU was the strongest predictor of death (hazard ratio > 4). Conclusions In severe AS, a higher number of IpcPH patients are diagnosed by the 2018 definition, even though they have the same prognosis as those without PH. Patients with true precapillary PH are more accurately identified by the 2018 definition that includes a pulmonary vascular disease criterion, that is, PVR ≥3 WU, a strong mortality predictor.

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Pulmonary hypertension associated with left heart disease: Updated Recommendations of the Cologne Consensus Conference 2018

Cited by 55 publications

References 100 publications

Risk stratification and prognostic factors in patients with pulmonary arterial hypertension and comorbidities a cross-sectional cohort study with survival follow-up

Risk stratification and prognostic factors in patients with pulmonary arterial hypertension and comorbidities a cross-sectional cohort study with survival follow-up

Pulmonale Hypertonie: Update 2019

Impact of the new pulmonary hypertension definition on long‐term mortality in patients with severe aortic stenosis undergoing valve replacement

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