Simonneau Gérald, Hoeper Marius M
Hôpital Universitaire de Bicêtre, Université Paris-Sud, 94275 Le Kremlin-Bicêtre, Paris, France.
Department of Respiratory Medicine, Hannover Medical School and German Center for Lung Research, 30625 Hannover, Germany.
Eur Heart J Suppl. 2019 Dec;21(Suppl K):K4-K8. doi: 10.1093/eurheartj/suz211. Epub 2019 Dec 17.
At the 6th World Symposium on Pulmonary Hypertension (PH), it was proposed that the mean pulmonary arterial pressure (mPAP) threshold used to define PH should be lowered from ≥25 mmHg to >20 mmHg. The rationale for this change is that the ≥25 mmHg threshold is arbitrary, whereas the revised threshold is based on scientific evidence. For the definition of all forms of pre-capillary PH, the inclusion of a pulmonary vascular resistance (PVR) ≥3 Wood Units was also proposed, placing greater emphasis on an elevated PVR to identify pulmonary vascular disease. Here, we discuss the possible impact of the revised definition of PH on future clinical management. This change may facilitate earlier PH detection, particularly in at-risk patient groups that are already undergoing screening programmes, e.g. those with systemic sclerosis or mutations associated with PH. As an mPAP above the upper limit of normal (>20 mmHg) but <25 mmHg is associated with increased risk of morbidity and mortality compared with a normal mPAP, early identification of patients in this group is important to enable close monitoring and timely treatment initiation once clinically indicated. Treatments currently approved for PH are not necessarily suitable for patients with an mPAP 21-24 mmHg, as the management of this group has not been widely examined. The revised definition may facilitate inclusion of these patients in prospective trials, allowing the evaluation of appropriate management strategies.
在第六届世界肺动脉高压（PH）研讨会上，有人提议将用于定义PH的平均肺动脉压（mPAP）阈值从≥25 mmHg降至>20 mmHg。这一变化的依据是，≥25 mmHg的阈值是随意设定的，而修订后的阈值是基于科学证据。对于所有形式的毛细血管前PH的定义，还提议纳入肺血管阻力（PVR）≥3 Wood单位，更加强调升高的PVR以识别肺血管疾病。在此，我们讨论PH修订定义对未来临床管理可能产生的影响。这一变化可能有助于更早地检测出PH，特别是在已经接受筛查项目的高危患者群体中，例如患有系统性硬化症或与PH相关突变的患者。由于与正常mPAP相比，高于正常上限（>20 mmHg）但<25 mmHg的mPAP与发病和死亡风险增加相关，因此尽早识别该组患者对于一旦临床指征明确就能进行密切监测和及时开始治疗很重要。目前批准用于PH的治疗方法不一定适用于mPAP为21 - 24 mmHg的患者，因为该组患者的管理尚未得到广泛研究。修订后的定义可能有助于将这些患者纳入前瞻性试验，从而能够评估适当的管理策略。
