Kularatne Mithum, Gerges Christian, Jevnikar Mitja, Humbert Marc, Montani David
Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada.
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria.
J Cardiovasc Dev Dis. 2024 Feb 27;11(3):78. doi: 10.3390/jcdd11030078.
Pulmonary hypertension (PH) refers to a pathologic elevation of the mean pulmonary artery pressure (mPAP) and is associated with increased morbidity and mortality in a wide range of medical conditions. These conditions are classified according to similarities in pathophysiology and management in addition to their invasive hemodynamic profiles. The 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension present the newest clinical classification system and includes significant updates to the hemodynamic definitions. Pulmonary hypertension is now hemodynamically defined as an mPAP > 20 mmHg, reduced from the previous threshold of ≥25 mmHg, due to important insights from both normative and prognostic data. Pulmonary vascular resistance has been extended into the definition of pre-capillary pulmonary hypertension, with an updated threshold of >2 Wood Units (WU), to help differentiate pulmonary vascular disease from other causes of increased mPAP. Exercise pulmonary hypertension has been reintroduced into the hemodynamic definitions and is defined by an mPAP/cardiac output slope of >3 mmHg/L/min between rest and exercise. While these new hemodynamic thresholds will have a significant impact on the diagnosis of pulmonary hypertension, no evidence-based treatments are available for patients with mPAP between 21-24 mmHg and/or PVR between 2-3 WU or with exercise PH. This review highlights the evidence underlying these major changes and their implications on the diagnosis and management of patients with pulmonary hypertension.
肺动脉高压（PH）是指平均肺动脉压（mPAP）的病理性升高，在多种医疗状况下与发病率和死亡率增加相关。这些状况除了根据其有创血流动力学特征进行分类外，还根据病理生理学和管理方面的相似性进行分类。2022年欧洲心脏病学会（ESC）/欧洲呼吸学会（ERS）肺动脉高压诊断和治疗指南提出了最新的临床分类系统，并对血流动力学定义进行了重大更新。由于来自规范数据和预后数据的重要见解，目前肺动脉高压在血流动力学上被定义为mPAP>20 mmHg，较之前≥25 mmHg的阈值有所降低。肺血管阻力已被纳入毛细血管前肺动脉高压的定义中，更新后的阈值为>2伍德单位（WU），以帮助区分肺血管疾病与其他导致mPAP升高的原因。运动性肺动脉高压已重新纳入血流动力学定义，定义为静息和运动之间mPAP/心输出量斜率>3 mmHg/L/min。虽然这些新的血流动力学阈值将对肺动脉高压的诊断产生重大影响，但对于mPAP在21 - 24 mmHg之间和/或肺血管阻力在2 - 3 WU之间或患有运动性肺动脉高压的患者，尚无循证治疗方法。本综述强调了这些重大变化背后的证据及其对肺动脉高压患者诊断和管理的影响。
