Nathan Steven D, Barnett Scott D, King Christopher S, Provencher Steeve, Barbera Joan A, Pastre Jean, Shlobin Oksana A, Seeger Werner
Inova Fairfax Hospital, Falls Church, VA, USA.
Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Quebec City, Canada.
Pulm Circ. 2021 Mar 30;11(2):2045894021999960. doi: 10.1177/2045894021999960. eCollection 2021 Apr-Jun.
The implications of the recent change in the definition of pulmonary hypertension on epidemiology and outcomes are not known. We sought to determine the percentage of patients with the two most common lung diseases that would be reclassified regarding the presence/absence of pulmonary hypertension with the revised definition. A query of the United Network for Organ Sharing database was performed. The percentage of patients meeting the current and previous definition of pulmonary hypertension was described. Outcomes of patients stratified by the current and previous definitions were compared. There were 15,563 patients with right heart catheterization data analyzed. Pulmonary hypertension was more prevalent in both chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis under the new definition at 52.4% versus 82.4%, and 47.6% versus 73.6%, respectively. "Pre-capillary" pulmonary hypertension by the new definition was lower at 28.1% for chronic obstructive pulmonary disease and 36.8% for idiopathic pulmonary fibrosis. Of the patients with pulmonary hypertension by the old definition, 23.9% of chronic obstructive pulmonary disease patients and 18.7% of idiopathic pulmonary fibrosis patients were not classified as pulmonary hypertension by the new definition. Conversely, 15.9% of chronic obstructive pulmonary disease patients and 15.1% of idiopathic pulmonary fibrosis patients who did not meet diagnostic criteria for pulmonary hypertension by the old definition did have pulmonary hypertension by the new definition. Patients in both disease categories had shorter transplant-free waitlist survival in the presence of pulmonary hypertension by both the new and old definitions. There was a trend toward the new definition of pre-capillary pulmonary hypertension better discerning outcomes compared to the old definition of pulmonary hypertension in idiopathic pulmonary fibrosis patients. Most patients with advanced lung disease who are listed for lung transplantation have pulmonary hypertension, but fewer have pre-capillary pulmonary hypertension than pulmonary hypertension by the old definition. Both the old and new definition of precapillary pulmonary hypertension appear to discern outcomes among the two groups of lung disease analyzed, with some evidence to suggest that the new definition performs slightly better in the idiopathic pulmonary fibrosis population.
肺动脉高压定义的近期变化对流行病学和预后的影响尚不清楚。我们试图确定两种最常见肺部疾病患者中，根据修订后的定义，因肺动脉高压的存在与否而重新分类的患者百分比。对器官共享联合网络数据库进行了查询。描述了符合肺动脉高压当前和先前定义的患者百分比。比较了根据当前和先前定义分层的患者的预后。共分析了15563例有右心导管检查数据的患者。在新定义下，肺动脉高压在慢性阻塞性肺疾病和特发性肺纤维化中更为普遍，分别为52.4%对82.4%，以及47.6%对73.6%。根据新定义，“毛细血管前”肺动脉高压在慢性阻塞性肺疾病中较低，为28.1%，在特发性肺纤维化中为36.8%。在旧定义下患有肺动脉高压的患者中，23.9%的慢性阻塞性肺疾病患者和18.7%的特发性肺纤维化患者根据新定义未被归类为肺动脉高压。相反，在旧定义下不符合肺动脉高压诊断标准的慢性阻塞性肺疾病患者中，15.9%以及特发性肺纤维化患者中15.1%根据新定义确实患有肺动脉高压。在新老定义下，这两种疾病类别中存在肺动脉高压的患者在等待移植名单上的无移植生存期均较短。在特发性肺纤维化患者中，与旧的肺动脉高压定义相比，新的毛细血管前肺动脉高压定义在区分预后方面有更好的趋势。大多数列入肺移植名单的晚期肺病患者患有肺动脉高压，但与旧定义的肺动脉高压相比，患有毛细血管前肺动脉高压的患者较少。毛细血管前肺动脉高压的新旧定义似乎都能区分所分析的两组肺病患者的预后，有一些证据表明新定义在特发性肺纤维化人群中表现略好。
