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. 2021 Jul 15:335:105-110.
doi: 10.1016/j.ijcard.2021.04.006. Epub 2021 Apr 3.

Impact of the new definition of pulmonary hypertension according to world symposium of pulmonary hypertension 2018 on diagnosis of post-capillary pulmonary hypertension

Elena Pfeuffer-Jovic  1 , Simon Weiner  2 , Heinrike Wilkens  3 , Delia Schmitt  4 , Stefan Frantz  5 , Matthias Held  4
Affiliations

Impact of the new definition of pulmonary hypertension according to world symposium of pulmonary hypertension 2018 on diagnosis of post-capillary pulmonary hypertension

Elena Pfeuffer-Jovic et al. Int J Cardiol. .

Abstract

Background: The World Symposium on Pulmonary Hypertension (WSPH) in 2018 recommended new definitions of pulmonary hypertension (PH). We investigated the impact of the updated definition on prevalence of PH due to left heart disease (PH-LHD).

Methods: The data of right heart catheterizations in patients with suspected PH-LHD between January 2008 and July 2015 was retrospectively analyzed applying different definitions. The number of patients diagnosed by the updated WSPH hemodynamic criteria of a mean pulmonary artery pressure (mPAP) > 20 mmHg was compared to the number of patients using mPAP ≥ 25 mmHg. The differentiation between patients with isolated post-capillary (Ipc) and combined post-capillary and pre-capillary (Cpc) PH was analyzed comparing the ESC/ERS guidelines, the recommendation of Cologne Consensus Conference (CCC) and WSPH.

Results: Of the 726 patients with a suspected PH, 58 patients met the diagnostic criteria of the ESC/ERS guidelines for PH-LHD with 32.8% Ipc-cases, 34.4% Cpc-PH-cases and 32.8% unclassifiable cases. Overall, 58 patients were diagnosed by the CCC criteria, with 34.5% classified as Cpc-PH and 65.5% as Icp-PH. Using the criteria of WSPH, the number of PH-LHD rose by one patient. According to the new definition, 64.4% of the patients were classified as Cpc-PH and had a significantly higher right to left atrial area (RA/LA) ratio than Ipc-PH patients.

Conclusion: Applying the new recommendation, the number of diagnosed patients with PH-LHD increases marginally. There is, however, a relevant shift in the number of Cpc-PH cases. An elevated RA/LA ratio might help to identify patients for invasive diagnostic work-up.

Keywords: Combined post-capillary and pre-capillary pulmonary hypertension; Mean pulmonary arterial pressure; Post-capillary pulmonary hypertension; Pulmonary vascular resistance.

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Conflict of interest statement

Declaration of competing interest Dr. Pfeuffer-Jovic reports fees for travel/accommodation from Actelion, Boehringer Ingelheim, Novartis and OMT, outside the submitted work. Simon Weiner has nothing to disclose. Prof. Dr. Wilkens has received personal fees for lectures and/or advisory board activities from Actelion, Janssen, Bayer Healthcare, Boehringer Ingelheim, GSK, MSD, Pfizer and Roche. Delia Schmitt has nothing to disclose. Prof. Dr. Frantz got support from the BMBF, Abiomed, Amgen, Akzea, AstraZeneca, Bayer, Berlin-Chemie, Braun, Bristol-Myers Squibb, Boehringer, Daiichi Sankyo, MSD, Novartis, Pfizer, Sanofi-Aventis, Servier, Siemens, Zoll. PD Dr. Held reports grants from Actelion, honoraria for lectures from Actelion, Bayer HealthCare, Berlin Chemie, Boehringer Ingelheim, GSK, Novartis, Pfizer, honoraria for advisory board activities from Actelion, Bayer HealthCare, GSK, MSD, and participation in clinical trials of Actelion, Bayer HealthCare, GSK, Pfizer, United Therapeutics, outside the submitted work.

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