Tanyeri Seda, Akbal Ozgur Y, Keskin Berhan, Hakgor Aykun, Karagoz Ali, Tokgoz Hacer Ceren, Dogan Cem, Bayram Zubeyde, Kulahcioglu Seyhmus, Erdogan Emrah, Balaban Ismail, Ceneli Dogancan, Acar Rezzan Deniz, Tanboga Ibrahim H, Ozdemir Nihal, Kaymaz Cihangir
University of Health Sciences, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey.
Department of Biostatistics, Medical School, Ataturk University, Erzurum, Turkey.
Pulm Circ. 2020 Aug 28;10(3):2045894020931299. doi: 10.1177/2045894020931299. eCollection 2020 Jul-Sep.
We evaluated whether updated pulmonary hypertension definitive criteria proposed in sixth World Symposium on Pulmonary Hypertension had an impact on diagnosis of overall pulmonary hypertension and pre-capillary and combined pre- and post-capillary phenotypes as compared to those in European Society of Cardiology/European Respiratory Society 2015 pulmonary hypertension Guidelines. Study group comprised the retrospectively evaluated 1300 patients (age 53.1 ± 18.8 years, female 807, 62.1%) who underwent right heart catheterization with different indications between 2006 and 2018. Mean pulmonary arterial pressure ≥25 mmHg (European Society of Cardiology) and PAMP (mean pulmonary arterial pressure) >20 mmHg (World Symposium on Pulmonary Hypertension) right heart catheterization definitions criteria were used, respectively. For pre-capillary pulmonary hypertension, pulmonary artery wedge pressure ≤15 mmHg and pulmonary vascular resistance ≥3 Wood units criteria were included in the both definitions. Normal mean pulmonary arterial pressure (<21 mmHg), borderline mean pulmonary arterial pressure elevation (21-24 mmHg), and overt pulmonary hypertension (≥25 mmHg) were documented in 21.1, 9.8, and 69.1% of the patients, respectively. The pre-capillary and combined pre- and post-capillary pulmonary hypertension were noted in 2.9 and 1.1%, 8.7 and 2.5%, and 34.6 and 36.6% of the patients with normal mean pulmonary arterial pressure, borderline, and overt pulmonary hypertension subgroups, respectively. The World Symposium on Pulmonary Hypertension versus European Society of Cardiology/European Respiratory Society definitions resulted in a net 9.8% increase in the diagnosis of overall pulmonary hypertension whereas increases in the pre-capillary pulmonary hypertension and combined pre- and post-capillary pulmonary hypertension diagnosis were only 0.8 and 0.3%, respectively. The re-definition of mean pulmonary arterial pressure threshold seems to increase the frequency of the overall pulmonary hypertension diagnosis. However, this increase was mainly originated from those in post-capillary pulmonary hypertension subgroup whereas its impact on pre-capillary and combined pre- and post-capillary pulmonary hypertension was negligible. Moreover, criteria of pre-capillary pulmonary vascular disease and combined pre- and post-capillary phenotypes were still detectable even in the presence of normal mean pulmonary arterial pressure. The obligatory criteria of pulmonary vascular resistance ≥3 Wood units seems to keep specificity for discrimination between pre-capillary versus post-C pulmonary hypertension after lowering the definitive mean pulmonary arterial pressure threshold to 20 mmHg.
我们评估了第六届世界肺动脉高压研讨会提出的更新后的肺动脉高压确诊标准，与欧洲心脏病学会/欧洲呼吸学会2015年肺动脉高压指南相比，对整体肺动脉高压以及毛细血管前性和毛细血管前与后混合性表型诊断的影响。研究组包括对2006年至2018年间因不同适应证接受右心导管检查的1300例患者（年龄53.1±18.8岁，女性807例，占62.1%）进行回顾性评估。分别采用平均肺动脉压≥25mmHg（欧洲心脏病学会标准）和肺动脉平均压（PAMP）>20mmHg（世界肺动脉高压研讨会标准）的右心导管检查定义标准。对于毛细血管前性肺动脉高压，两种定义均纳入肺动脉楔压≤15mmHg和肺血管阻力≥3伍德单位的标准。平均肺动脉压正常（<21mmHg）、临界性平均肺动脉压升高（21 - 24mmHg）和显性肺动脉高压（≥25mmHg）的患者分别占21.1%、9.8%和69.1%。在平均肺动脉压正常、临界性和显性肺动脉高压亚组的患者中，毛细血管前性以及毛细血管前与后混合性肺动脉高压分别占2.9%和1.1%、8.7%和2.5%、34.6%和36.6%。与欧洲心脏病学会/欧洲呼吸学会的定义相比，世界肺动脉高压研讨会的定义使整体肺动脉高压的诊断净增加了9.8%，而毛细血管前性肺动脉高压和毛细血管前与后混合性肺动脉高压诊断的增加分别仅为0.8%和0.3%。平均肺动脉压阈值的重新定义似乎增加了整体肺动脉高压的诊断频率。然而，这种增加主要源于毛细血管后性肺动脉高压亚组，而其对毛细血管前性以及毛细血管前与后混合性肺动脉高压的影响可忽略不计。此外，即使在平均肺动脉压正常的情况下，毛细血管前性肺血管疾病以及毛细血管前与后混合性表型的标准仍然可以检测到。将确诊的平均肺动脉压阈值降至20mmHg后，肺血管阻力≥3伍德单位这一强制性标准似乎保持了区分毛细血管前性与毛细血管后性肺动脉高压的特异性。
Zotero 插件