Key result
Revised pulmonary hypertension definition identifies increased mortality risk using mPAP >20 mmHg and PVR ≥2.2 WU.
Accurate right heart catheterization with updated hemodynamic thresholds (mPAP >20 mmHg, PVR ≥2.2 WU) is essential for the early diagnosis and risk stratification of pulmonary hypertension, especially in left heart disease.
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Supports revised mPAP and PVR thresholds for earlier PH detection; leaves open prospective validation of mortality associations.
Pulmonary hypertension (PH) is an independent risk factor for adverse clinical outcome, particularly in left heart disease (LHD) patients. Recent advances have clarified the mean pulmonary artery pressure (mPAP) range that is above normal and associated with clinical events, including mortality. This progress has for the first time resulted in a new clinical definition of PH that is evidenced-based, inclusive of mPAP >20 mmHg, and emphasizes early diagnosis. Additionally, pulmonary vascular resistance (PVR)=2.2–3.0 WU, considered previously to be normal, appears to associate with elevated clinical risk. A revised approach to classifying PH patients as pre-capillary, isolated post-capillary, or combined pre-/post-capillary PH now guides point-of-care diagnosis, risk stratification, and treatment. Exercise hemodynamic or confrontational fluid challenge studies may also aid decision-making for patients with PH-LHD or otherwise unexplained dyspnea. This collective progress in pulmonary vascular and heart failure medicine reinforces the critical importance of accurate hemodynamic assessment (Central Illustration).
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Maron et al. (2020) conducted a review in Pulmonary hypertension and heart failure. Elevated mean pulmonary artery pressure (>20 mmHg) and pulmonary vascular resistance (≥2.2 WU) vs. Normal hemodynamic parameters was evaluated. A revised evidence-based clinical definition of pulmonary hypertension emphasizes early diagnosis using mean pulmonary artery pressure >20 mmHg and pulmonary vascular resistance ≥2.2 WU, both of which are associated with increased mortality risk.
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