ISSN 1016-5169 | E-ISSN 1308-4488
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Definitions and diagnosis of pulmonary hypertension [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2014; 42(1): 55-66

Definitions and diagnosis of pulmonary hypertension

Marius M. Hoeper1, Harm Jan Bogaard2, Robin Condliffe3, Robert Frantz4, Dinesh Khanna5, Marcin Kurzyna6, David Langleben7, Alessandra Manes8, Toru Satoh9, Fernando Torres10, Martin R. Wilkins11, David B. Badesch12
1German Research Center for Pulmonary and Respiratory Diseases Department, Hannover Medical School, Hannover, Germany
2VU University Medical Center, Department of Chest Diseases, Amsterdam, Netherlands
3Royal Hallamshire Hospital, Department of Thoracic and Vascular Diseases, Sheffield, England
4Mayo Clinic, Medical Clinic, Rochester, Minnesota, USA
5Scleroderma Program of the University of Michigan, Ann Arbor, Michigan, USA
6Postgraduate Medical Centre, Pulmonary Circulation and Thromboembolic Diseases, Warsaw, Poland
7Pulmonary Vascular Disease Center, Department of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
8Experimental Diagnostic and DIMES Private Medical Unit, University Hospital of Bologna, Bologna, Italy
9Kyorin University School of Medicine, Department of Cardiology, Tokyo, Japan
10University of Texas Southwestern Medical Center, Pulmonary Hypertension Program, Dallas, Texas, USA
11London Imperial College, Experimental Medicine, London, England
12University of Colorado Pulmonary Sciences and Critical Care and Cardiology Department, Denver, Colorado, USA

Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure 25 mm Hg at rest, measured during right heart catheterization. There is still insufficient evidence to add an exercise criterion to this definition. The term pulmonary arterial hypertension (PAH) describes a subpopulation of patients with PH characterized hemodynamically by the presence of pre-capillary PH including an end-expiratory pulmonary artery wedge pressure (PAWP) 15 mm Hg and a pulmonary vascular resistance >3 Wood units. Right heart catheterization remains essential for a diagnosis of PH or PAH. This procedure requires further standardization, including uniformity of the pressure transducer zero level at the midthoracic line, which is at the level of the left atrium. One of the most common problems in the diagnostic workup of patients with PH is the distinction between PAH and PH due to left heart failure with preserved ejection fraction (HFpEF). A normal PAWP does not rule out the presence of HFpEF. Volume or exercise challenge during right heart catheterization may be useful to unmask the presence of left heart disease, but both tools require further evaluation before their use in general practice can be recommended. Early diagnosis of PAH remains difficult, and screening programs in asymptomatic patients are feasible only in high-risk populations, particularly in patients with systemic sclerosis, for whom recent data suggest that a combination of clinical assessment and pulmonary function testing including diffusion capacity for carbon monoxide, biomarkers, and echocardiography has a higher predictive value than echocardiography alone. (J Am Coll Cardiol 2013;62: D42–50) ©2013 by the American College of Cardiology Foundation.

Keywords: Hemodynamics, pulmonary hypertension, right heart catheterization, diagnosis; screening

How to cite this article
Marius M. Hoeper, Harm Jan Bogaard, Robin Condliffe, Robert Frantz, Dinesh Khanna, Marcin Kurzyna, David Langleben, Alessandra Manes, Toru Satoh, Fernando Torres, Martin R. Wilkins, David B. Badesch. Definitions and diagnosis of pulmonary hypertension. Turk Kardiyol Dern Ars. 2014; 42(1): 55-66

Corresponding Author: Marius M. Hoeper, Germany
Manuscript Language: Turkish


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