Critical Care Medicine Department, Pulmonary Vascular Biology Section, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Curr Opin Pulm Med. 2020 Sep;26(5):384-390. doi: 10.1097/MCP.0000000000000699.
The 6th World Symposium on Pulmonary Hypertension (WSPH) proposed lowering the mean pulmonary artery pressure (mPAP) threshold that defines pulmonary hypertension from ≥ 25 to > 20 mmHg. The historical context and evolution of the pulmonary hypertension definition and the data used to rationalize recent changes are reviewed here.
There are accumulating data on the clinical significance of mildly elevated mPAPs (21-24 mmHg). Studies have demonstrated lower exercise capacity and an increased risk of progression to overt pulmonary hypertension (mPAP ≥ 25 mmHg) in specific at-risk patient populations. Further, large registries across diverse pulmonary hypertension populations have identified increased mortality in patients with mPAPs 21-24 mmHg. Although the clinical sequelae of lowering the mPAP threshold remain unclear, this uncertainty has fueled recent debates within the pulmonary hypertension community.
The changes to the pulmonary hypertension definition proposed by the 6th WSPH are supported by normative hemodynamic data in healthy individuals as well as studies demonstrating an association between mPAPs above this normal range and increased mortality. Whether the higher mortality observed in patients with mildly elevated mPAPs is directly attributable to pulmonary vascular disease that is amenable to therapeutic intervention remains to be determined.
第六届世界肺动脉高压研讨会（WSPH）提议将肺动脉高压的平均肺动脉压（mPAP）定义阈值从≥25mmHg 降低至＞20mmHg。本文回顾了肺动脉高压定义的历史背景和演变，以及用于合理化最近变化的数据。
关于轻度升高的 mPAP（21-24mmHg）的临床意义有越来越多的数据。研究表明，在特定的高危患者人群中，运动能力降低，进展为明显的肺动脉高压（mPAP≥25mmHg）的风险增加。此外，在不同肺动脉高压患者群体的大型登记处中，mPAP 为 21-24mmHg 的患者死亡率增加。尽管降低 mPAP 阈值的临床后果仍不清楚，但这种不确定性引发了肺动脉高压界内的近期争论。
第六届 WSPH 提出的肺动脉高压定义的变化得到了健康个体正常范围内的血流动力学数据以及表明该正常范围以上的 mPAP 与死亡率增加之间存在关联的研究的支持。在轻度升高的 mPAP 患者中观察到的更高死亡率是否直接归因于可通过治疗干预的肺血管疾病，还有待确定。
