Department of Internal Medicine, Respiratory Medicine and Ventilatory Support, Medical Mission Hospital, Central Clinic Würzburg, Academic Teaching Hospital of the Julius Maximilian University of Würzburg, Würzburg, Germany.
Department of Diagnostic and Interventional Neuroradiology, Julius Maximilian University of Würzburg, Würzburg, Germany.
Int J Cardiol. 2021 Jul 15;335:105-110. doi: 10.1016/j.ijcard.2021.04.006. Epub 2021 Apr 3.
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).
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.
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.
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.
2018 年世界肺高血压研讨会（WSPH）推荐了肺高血压（PH）的新定义。我们研究了更新定义对左心疾病相关 PH（PH-LHD）患病率的影响。
回顾性分析 2008 年 1 月至 2015 年 7 月疑似 PH-LHD 患者的右心导管检查数据，应用不同的定义。比较采用更新的 WSPH 血流动力学标准（平均肺动脉压 mPAP＞20mmHg）诊断的患者数量与采用 mPAP≥25mmHg 诊断的患者数量。通过比较 ESC/ERS 指南、科隆共识会议（CCC）和 WSPH 的建议，分析将患者分为单纯毛细血管后（Ipc）和毛细血管后和前毛细血管（Cpc）PH 的差异。
在 726 例疑似 PH 患者中，58 例符合 ESC/ERS 指南 PH-LHD 诊断标准，其中 32.8%为 Ipc 型病例，34.4%为 Cpc-PH 型病例，32.8%为无法分类病例。总体而言，58 例患者符合 CCC 标准，其中 34.5%归类为 Cpc-PH，65.5%归类为 Icp-PH。采用 WSPH 标准，PH-LHD 患者数量增加 1 例。根据新定义，64.4%的患者被归类为 Cpc-PH，其右心房/左心房面积（RA/LA）比值明显高于 Ipc-PH 患者。
应用新建议，诊断为 PH-LHD 的患者数量略有增加。然而，Cpc-PH 病例的数量有明显的变化。升高的 RA/LA 比值可能有助于识别需要进行有创性诊断检查的患者。
