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Clinical Impact of the New Definition of Precapillary Pulmonary Hypertension

Published:January 04, 2021DOI:https://doi.org/10.1016/j.chest.2020.11.070
      At the 6th World Symposium on Pulmonary Hypertension, precapillary pulmonary hypertension (PH) has been defined as mean pulmonary arterial pressure (mPAP) >20 mm Hg with a pulmonary arterial wedge pressure (PAWP) ≤15 mm Hg and pulmonary vascular resistance (PVR) ≥3 Wood units (WU; new definition).
      • Simonneau G.
      • Montani D.
      • Celermajer D.S.
      • et al.
      Haemodynamic definitions and updated clinical classification of pulmonary hypertension.
      According to the 2015 European Society of Cardiology and the European Respiratory Society guidelines for the diagnosis and treatment of PH, the previous hemodynamic definition of precapillary PH was mPAP ≥25 mm Hg with PAWP ≤15 mm Hg (previous definition)
      • Galie N.
      • Humbert M.
      • Vachiery J.L.
      • et al.
      2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).
      with the caveat that, for a diagnosis of pulmonary arterial hypertension (PAH), PVR had to be ≥3 WU. As a consequence of the lowered mPAP threshold and the extension of the PVR threshold to all forms of precapillary PH in the new definition, the number of patients with precapillary PH will increase by those with mPAP 21 to 24 mm Hg and PVR ≥3 WU and decrease by those with mPAP ≥25 mm Hg and PVR <3 WU. The goal of the new definition was to close the gap between the upper limit of normal mPAP
      • Kovacs G.
      • Berghold A.
      • Scheidl S.
      • Olschewski H.
      Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review.
      and the definition of PH, to promote the early recognition of pulmonary vascular disease, and to exclude patients with mild mPAP increase due to causes other than pulmonary vascular disease from the precapillary PH group.
      • Simonneau G.
      • Montani D.
      • Celermajer D.S.
      • et al.
      Haemodynamic definitions and updated clinical classification of pulmonary hypertension.
      The aim of our study was to evaluate the effects of the new definition on the number and composition of patients with precapillary PH.
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      References

        • Simonneau G.
        • Montani D.
        • Celermajer D.S.
        • et al.
        Haemodynamic definitions and updated clinical classification of pulmonary hypertension.
        Eur Respir J. 2019; 53: 1801913
        • Galie N.
        • Humbert M.
        • Vachiery J.L.
        • et al.
        2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).
        Eur Heart J. 2016; 37: 67-119
        • Kovacs G.
        • Berghold A.
        • Scheidl S.
        • Olschewski H.
        Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review.
        Eur Respir J. 2009; 34: 888-894

      Linked Article

      • Response
        CHESTVol. 160Issue 5
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          We appreciate the interest and constructive comments of Zheng et al to our research letter on the clinical impact of the new definition of precapillary pulmonary hypertension (PH).1 We also welcome the opportunity to discuss potential treatment strategies for patients with mild pulmonary hemodynamic impairment, which has been addressed by the authors. In their letter, Zheng et al focused on potential changes in targeted PH therapy in those patients who either had precapillary PH according to previous criteria, but not according to the proposed new definition,2 or the other way around.
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      • The Impact of Clinical Treatment Plan of the New Definition of Precapillary Pulmonary Hypertension
        CHESTVol. 160Issue 5
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          We have read with great interest the recently published article in CHEST (May 2021) by Kovac et al,1 which indicates that the hemodynamic and clinical profiles of patients with “new precapillary pulmonary hypertension (PH)”2 correspond closely with the aims of the 6th World Symposium on Pulmonary Hypertension to recognize patients with early forms of pulmonary vascular disease and poor prognosis. We congratulate the authors on their efforts to shed further light on the relationship between the 2015 European Society of Cardiology/European Respiratory Society guidelines for the diagnosis and treatment of PH3 and the 6th World Symposium on PH.
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