Jin Qi, Zhang Yi, Zhao Zhihui, Zhao Qing, Yu Xue, Yan Lu, Li Xin, Duan Anqi, An Chenhong, Ma Xiuping, Xiong Changming, Luo Qin, Liu Zhihong
Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Cardiovasc Diagn Ther. 2021 Oct;11(5):1047-1057. doi: 10.21037/cdt-21-373.
In the 6 World Symposium on Pulmonary Hypertension (PH), the hemodynamic definition of PH was reduced from a mean pulmonary artery pressure (mPAP) ≥25 to >20 mmHg. This study aimed to evaluate the impact of the revised hemodynamic definition on the diagnosis of precapillary PH.
We retrospectively enrolled patients who underwent right heart catheterization from January 2012 to December 2018. All included patients were reassessed according to the revised hemodynamic definition.
A total of 1,251 patients were included for analysis, of whom 1,044 patients had precapillary PH and 182 patients had mPAP <25 mmHg. After applying the revised definition, 33 (18.1%) of 182 patients with mPAP <25 mmHg were reclassified as having PH. However, only 7 of these 33 patients had a pulmonary vascular resistance ≥3 wood units and could be considered to have precapillary PH, accounting for 0.7% of the existing precapillary PH population. More importantly, 12 patients with mPAP ≥25 mmHg were delisted from precapillary PH for pulmonary vascular resistance <3 wood units (5 patients from Group III, 4 patients from Group IV, 3 patients from Group V). Overall, there was a net 0.5% decrease [(12-7)/1044×100%] in the population with precapillary PH.
The revised hemodynamic definition had a minor impact on the diagnosis of precapillary PH. It should be noted that the revised definition would influence not only patients with mPAP =21-24 mmHg, but also patients with mPAP ≥25 mmHg.
在第六届世界肺动脉高压（PH）研讨会上，PH的血流动力学定义从平均肺动脉压（mPAP）≥25 mmHg降至>20 mmHg。本研究旨在评估修订后的血流动力学定义对毛细血管前性PH诊断的影响。
我们回顾性纳入了2012年1月至2018年12月期间接受右心导管检查的患者。所有纳入患者均根据修订后的血流动力学定义进行重新评估。
共纳入1251例患者进行分析，其中1044例患者患有毛细血管前性PH，182例患者mPAP<25 mmHg。应用修订后的定义后，182例mPAP<25 mmHg的患者中有33例（18.1%）被重新分类为患有PH。然而，这33例患者中只有7例肺血管阻力≥3 Wood单位，可被认为患有毛细血管前性PH，占现有毛细血管前性PH人群的0.7%。更重要的是，12例mPAP≥25 mmHg的患者因肺血管阻力<3 Wood单位而被排除在毛细血管前性PH之外（5例来自III组，4例来自IV组，3例来自V组）。总体而言，毛细血管前性PH人群净减少0.5%[（12 - 7）/1044×100%]。
修订后的血流动力学定义对毛细血管前性PH的诊断影响较小。需要注意的是，修订后的定义不仅会影响mPAP = 21 - 24 mmHg的患者，还会影响mPAP≥25 mmHg的患者。
