Key result
The updated definition of exercise pulmonary hypertension is characterized by a mean pulmonary arterial pressure/cardiac output slope >3 Wood units from rest to exercise.
Why the study?
The ESC/ERS guidelines updated the haemodynamic definitions of pulmonary hypertension and introduced a new definition for exercise pulmonary hypertension, warranting a review of the underlying evidence.
This review summarizes the evidence supporting the reintroduction of exercise pulmonary hypertension in the ESC/ERS guidelines, defined by an mPAP/CO slope >3 WU.
Adoption of mPAP/CO slope >3 WU may refine exercise PH diagnosis; leaves open prospective validation across populations.
In the recently published European Society of Cardiology/European Respiratory Society guidelines on the diagnosis and treatment of pulmonary hypertension (PH) the haemodynamic definitions of PH were updated and a new definition for exercise PH was introduced. Accordingly, exercise PH is characterised by a mean pulmonary arterial pressure/cardiac output (CO) slope >3 Wood units (WU) from rest to exercise. This threshold is supported by several studies demonstrating prognostic and diagnostic relevance of exercise haemodynamics in various patient cohorts. From a differential diagnostic point of view, an elevated pulmonary arterial wedge pressure/CO slope >2 WU may be suitable to identify post-capillary causes of exercise PH. Right heart catheterisation remains the gold standard to assess pulmonary haemodynamics both at rest and exercise. In this review, we discuss the evidence that led to the reintroduction of exercise PH in the PH definitions.
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Zeder et al. (2022) conducted a review in Pulmonary hypertension. Exercise pulmonary hypertension definition was evaluated. The updated definition of exercise pulmonary hypertension is characterized by a mean pulmonary arterial pressure/cardiac output slope >3 Wood units from rest to exercise.
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