Key result
Revised hemodynamic definition reduces precapillary pulmonary hypertension diagnoses by a net ~0.5%.
Why the study?
The World Symposium on Pulmonary Hypertension revised the hemodynamic definition of PH from mPAP ≥25 to >20 mmHg, and the impact of this change on precapillary PH diagnosis was unclear.
Does the revised hemodynamic definition of pulmonary hypertension impact the diagnosis rate of precapillary pulmonary hypertension in patients undergoing right heart catheterization?
Observational (n=1,251)
No
Does the revised hemodynamic definition of pulmonary hypertension impact the diagnosis rate of precapillary pulmonary hypertension in patients undergoing right heart catheterization?
The revised hemodynamic definition of pulmonary hypertension (mPAP >20 mmHg) has a minimal net impact on the prevalence of precapillary PH diagnoses, as the requirement for PVR ≥3 wood units delists some previously diagnosed patients.
The revised definition yields minimal net change in precapillary PH prevalence; leaves open prognostic and therapeutic implications of reclassification.
BACKGROUND: World Symposium on Pulmonary Hypertension (PH), the hemodynamic definition of PH was reduced from a mean pulmonary artery pressure (mPAP) ≥25 to >20 mmHg. This study aimed to evaluate the impact of the revised hemodynamic definition on the diagnosis of precapillary PH. METHODS: We retrospectively enrolled patients who underwent right heart catheterization from January 2012 to December 2018. All included patients were reassessed according to the revised hemodynamic definition. RESULTS: A total of 1,251 patients were included for analysis, of whom 1,044 patients had precapillary PH and 182 patients had mPAP <25 mmHg. After applying the revised definition, 33 (18.1%) of 182 patients with mPAP <25 mmHg were reclassified as having PH. However, only 7 of these 33 patients had a pulmonary vascular resistance ≥3 wood units and could be considered to have precapillary PH, accounting for 0.7% of the existing precapillary PH population. More importantly, 12 patients with mPAP ≥25 mmHg were delisted from precapillary PH for pulmonary vascular resistance <3 wood units (5 patients from Group III, 4 patients from Group IV, 3 patients from Group V). Overall, there was a net 0.5% decrease [(12-7)/1044×100%] in the population with precapillary PH. CONCLUSIONS: The revised hemodynamic definition had a minor impact on the diagnosis of precapillary PH. It should be noted that the revised definition would influence not only patients with mPAP =21-24 mmHg, but also patients with mPAP ≥25 mmHg.
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Jin et al. (2021) conducted an observational in Precapillary pulmonary hypertension (n=1,251). Revised hemodynamic definition of pulmonary hypertension (mPAP >20 mmHg) vs. Previous hemodynamic definition (mPAP ≥25 mmHg) was evaluated on Diagnosis of precapillary pulmonary hypertension. Applying the revised hemodynamic definition of pulmonary hypertension resulted in a net 0.5% decrease in the population diagnosed with precapillary pulmonary hypertension.
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