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. 2024 May 29;4(3):oeae037.
doi: 10.1093/ehjopen/oeae037. eCollection 2024 May.

Impact of the 2022 pulmonary hypertension definition on haemodynamic classification and mortality in patients with aortic stenosis undergoing valve replacement

Micha T Maeder  1   2 , Lukas Weber  1 , Susanne Pohle  3 , Joannis Chronis  1 , Florent Baty  3 , Johannes Rigger  1 , Martin Brutsche  2   3 , Philipp Haager  1 , Hans Rickli  1 , Roman Brenner  1
Affiliations

Impact of the 2022 pulmonary hypertension definition on haemodynamic classification and mortality in patients with aortic stenosis undergoing valve replacement

Micha T Maeder et al. Eur Heart J Open. .

Abstract

Aims: With the 2022 pulmonary hypertension (PH) definition, the mean pulmonary artery pressure (mPAP) threshold for any PH was lowered from ≥25 to >20 mmHg, and the pulmonary vascular resistance (PVR) value to differentiate between isolated post-capillary PH (IpcPH) and combined pre- and post-capillary PH (CpcPH) was reduced from >3 Wood units (WU) to >2 WU. We assessed the impact of this change in the PH definition in aortic stenosis (AS) patients undergoing aortic valve replacement (AVR).

Methods and results: Severe AS patients (n = 503) undergoing pre-AVR cardiac heart catheterization were classified according to both the 2015 and 2022 definitions. The post-AVR mortality [median follow-up 1348 (interquartile range 948-1885) days] was assessed. According to the 2015 definition, 219 (44% of the entire population) patients had PH: 63 (29%) CpcPH, 125 (57%) IpcPH, and 31 (14%) pre-capillary PH. According to the 2022 definition, 321 (+47%) patients were diagnosed with PH, and 156 patients (31%) were re-classified: 26 patients from no PH to IpcPH, 38 from no PH to pre-capillary PH, 38 from no PH to unclassified PH, 4 from pre-capillary PH to unclassified PH, and 50 from IpcPH to CpcPH (CpcPH: +79%). With both definitions, only the CpcPH patients displayed increased mortality (hazard ratios ≈ 4). Among the PH-defining haemodynamic components, PVR was the strongest predictor of death.

Conclusion: In severe AS, the application of the 2022 PH definition results in a substantially higher number of patients with any PH as well as CpcPH. With either definition, CpcPH patients have a significantly increased post-AVR mortality.

Keywords: Aortic stenosis; Definition; Pulmonary artery compliance; Pulmonary artery pressure; Pulmonary hypertension; Pulmonary vascular resistance.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Graphical abstract
Graphical abstract
AS, aortic stenosis; CO2, carbon dioxide; CpcPH, combined pre- and post-capillary pulmonary hypertension; IpcPH, isolated post-capillary pulmonary hypertension; LA, left atrium; LV, left ventricle; mPAP, mean pulmonary artery pressure; mPAWP, mean pulmonary artery wedge pressure; O2, oxygen; PVR, pulmonary vascular resistance; PH, pulmonary hypertension.
Figure 1
Figure 1
Bar graph showing the proportion of patients (n = 503) with combined pre- and post-capillary pulmonary hypertension (CpcPH), isolated post-capillary PH (IpcPH), pre-capillary PH, unclassified PH, and without PH according to the 2015 and 2022 definitions and the re-classification steps.
Figure 2
Figure 2
Kaplan–Meier plots showing cumulative events (mortality) for patients with combined pre- and post-capillary pulmonary hypertension (CpcPH), isolated post-capillary PH (IpcPH), pre-capillary PH, and no PH according to the 2015 definition.
Figure 3
Figure 3
Kaplan–Meier plots showing cumulative events (mortality) for patients with combined pre- and post-capillary pulmonary hypertension (CpcPH), isolated post-capillary PH (IpcPH), pre-capillary PH, unclassified PH, and no PH according to the 2022 definition.
Figure 4
Figure 4
Kaplan–Meier plots showing cumulative events (mortality) according to single haemodynamic parameters. The four categories represent quartiles (Q) for mean pulmonary artery pressure (A), mean pulmonary artery wedge pressure (B), pulmonary vascular resistance (C), and pulmonary artery compliance (D).
See this image and copyright information in PMC

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