Clinical phenotypes and the risk factors of mild pulmonary hypertension

Figure 1. The relationship in hemodynamic classification between the 2015 and 2022 ESC/ERS PH guidelines. Sankey plot shows the relationship in hemodynamic classification between the 2015 and 2022 ESC/ERS PH guidelines. Left boxes indicate hemodynamic PH classification according to the 2015 PH guideline; right boxes indicate the classification according to the 2022 PH guideline; and lines between the boxes indicate the transition in the classification from the 2015 guideline to the 2022 guideline (gray, those with mPAP 21–24 mmHg; light blue, pre-capillary PH; green, isolated post-capillary PH; yellow, combined post- and pre-capillary PH; and orange, unclassified PH). Although unclassified PH was not defined in the 2015 guideline, we categorize unclassified PH using criteria (PVR ≤3 Wood units and PAWP ≤15 mmHg) based on the 2022 guideline. ESC, European Society of Cardiology; ERS, European Respiratory Society; mPAP, mean pulmonary artery pressure; PAWP, pulmonary arterial wedge pressure; PH, pulmonary hypertension; PVR, pulmonary vascular resistance.

Figure 2. Event-free survival of the composite outcome of all-cause mortality, heart failure hospitalization and lung transplant. Kaplan-Meier method with the comparison among the groups by log-rank test. A total of 228 composite outcome was recorded during the follow-up period (median [16.1–60.1], 42.0 months). Compared with no PH group, mild and conventional PH groups showed the higher incidence of the composite outcome (15.8% vs. 21.9% vs. 39.0%, log-rank p<0.001).

Figure 3. Event-free survival curve for the composite endpoint according to PH clinical classification. Event-free survival for the composite endpoint according to PH clinical classification in overall PH patients (A), the mild PH group (B), and the conventional PH group (C). Group1 as pulmonary arterial hypertension; Group 2 as PH associated with left heart failure; Group 3 as PH associated with lung diseases and/or hypoxia; Group 4 as PH associated with pulmonary artery obstructions; and Group 5 as PH with unclear and/or multifactorial mechanisms (Supplementary Table S2). The difference in PH clinical classification was tested by log-rank test.