Impact of the New Pulmonary Hypertension Definition on Heart Transplant Outcomes

Crawford, Todd C.; Leary, Peter J.; Fraser, Charles D.; Suarez‐Pierre, Alejandro; Magruder, J. Trent; Baumgartner, William A.; Zehr, Kenton J.; Whitman, Glenn J.R.; Masri, Sofia Carolina; Sheikh, Farooq H.; Marco, Teresa De; Maron, Bradley A.; Sharma, Kavita; Gilotra, Nisha A.; Russell, Stuart D.; Houston, Brian A.; Ramu, Bhavadharini; Tedford, Ryan J.

doi:10.1016/j.chest.2019.07.028

Cited by 35 publications

(27 citation statements)

References 25 publications

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“…In heart transplant patients, elevations in pre-transplant PVR Fig. 1 Treatment algorithm for group 1 pulmonary arterial hypertension have been independently associated with increased 30-day post-transplant mortality [39]. Interestingly, increased mortality in transplant patients with elevated pre-transplant PVR was similar in patients with mPAP 20-24 mmHg.…”

Section: Update On Group 2 Phmentioning

confidence: 97%

Diagnosis and Management of Pulmonary Hypertension in the Modern Era: Insights from the 6th World Symposium

et al. 2019

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The past 20 years have seen major advances in the diagnosis and management of pulmonary hypertension, a disease associated with significant morbidity and mortality. The 6th World Symposium in Pulmonary Hypertension (WSPH) took place in February 2018 and attempted to consolidate the current knowledge in the field into practical recommendations to help prioritize an action plan to improve patient outcomes and identify future research directions. In this review, we will summarize the highlights of the 6th WSPH proceedings, including revisions to the hemodynamic definitions and classification of the various types of pulmonary hypertension, genetic advances, approaches to risk stratification, and updated treatment algorithms.

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Section: Update On Group 2 Phmentioning

confidence: 97%

Diagnosis and Management of Pulmonary Hypertension in the Modern Era: Insights from the 6th World Symposium

et al. 2019

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“…In fact, in the current study conventional PH-LHD criteria using only DPG (DPG �7 mmHg or not) provided the risk stratification of subjects to some extent, whereas the multivariate Cox regression analysis showed that there was no significant difference in adverse clinical outcomes observed between the Cpc-PH and Ipc-PH groups ( S2 Fig and S3 Table). Several studies had revealed PVR as a predictive index for clinical outcomes in patients with heart failure [37,39]. As for the risk stratification, conventional PH-LHD criteria using PVR alone (PVR �3 WU or not) could provide a clear risk stratification even after adjustment for confounding factors of heart failure in this study subjects (S1 Fig and S2 Table).…”

Section: Plos Onementioning

confidence: 74%

“…Therefore, a value of 20 mmHg as the upper limit of mPAP was appropriate even in PH-LHD. On the other hand, recent study reported that short-term mortality was not statistically different between elevated and normal mPAP group in elevated PVR settings in PH-LHD [37]. We developed further survival analysis using conventional PH criteria (mPAP �25 mmHg) and PVR to investigate whether the change of mPAP cut-off value to 20 mmHg from 25 mmHg was meaningful for prognostication.…”

Section: Plos Onementioning

confidence: 99%

Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure

et al. 2021

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Background The prognostic implications of combined pre- and post-capillary pulmonary hypertension (Cpc-PH) in patients with pulmonary hypertension due to left heart disease (PH-LHD) remain controversial. The aim of this retrospective study was to evaluate the new PH-LHD criteria, recommended by the 6th World Symposium on Pulmonary Hypertension and to determine the prognostic value of Cpc-PH. Methods A total of 701 patients with symptomatic heart failure who had undergone right-heart catheterization were divided into the following four groups: (i) Isolated post-capillary PH (Ipc-PH) group; mean pulmonary artery pressure (mPAP) >20 mmHg, pulmonary artery wedge pressure (PAWP) >15 mmHg, and pulmonary vascular resistance (PVR) <3 Wood units (WU) (ii) Cpc-PH group; mPAP >20 mmHg, PAWP >15 mmHg, and PVR ≥3 WU (iii) borderline-PH group; mPAP >20 mmHg and PAWP ≤15 mmHg (iv) non-PH group; mPAP ≤20 mmHg. Multivariate Cox hazard analysis was used to investigate whether Cpc-PH was associated with cardiac outcomes. Results The study subjects were allocated into the Ipc-PH (n = 268), Cpc-PH (n = 54), borderline-PH (n = 112), or non-PH (n = 267) groups. The Cpc-PH group was associated significantly with adverse cardiac events even after adjustment for clinically relevant confounding factors for heart failure prognosis (vs. non-PH group: HR 2.98 [95% CI 1.81–4.90], P <0.001; vs. Ipc-PH group: HR: 1.92 [95% CI 1.19–3.08], P = 0.007). Conclusions The new definitions of PH-LHD stratified patients into 4 categories. Long-term clinical outcomes were significantly different between the four categories, with Cpc-PH having the worst cardiac outcomes.

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“…eines PVR-Grenzwertes von ≥ 3 WU für das Vorliegen einer gemischten post-/präkapillären PH (PH bei Linksherzerkrankungen, Gruppe 2 der PH-Klassifikation) noch gut mit der prognostischen Bedeutung begründen lässt [15,16], muss dieser bei der präkapillären PH jedoch eher als arbiträr bzw. Konsens angesehen werden.…”

Section: Die Neue Definition Der Pulmonalen Hypertonieunclassified

Aktuelle Definition und Diagnostik der pulmonalen Hypertonie

et al. 2020

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ZusammenfassungDie 6. Weltkonferenz für pulmonale Hypertonie (PH) fand vom 27. 2. – 1. 3. 2018 in Nizza statt. Hier wurden die Erkenntnisse auf dem Gebiet der PH der letzten 5 Jahre nach Aufarbeitung und Diskussion über einen längeren Vorbereitungszeitraum von 13 Arbeitsgruppen präsentiert und in der Folge zum Jahreswechsel 2018/2019 publiziert. Einer der seither intensiv diskutierten Vorschläge ist der einer Änderung der hämodynamischen Definition der PH mit Absenkung des Grenzwertes für den mittleren pulmonalarteriellen Druck von ≥ 25 auf > 20 mmHg, gemessen im Rechtsherzkatheter in Ruhe. Zusätzlich wurde der pulmonalvaskuläre Widerstand in die PH-Definition aufgenommen, was die Wichtigkeit der Bestimmung des Herzzeitvolumens während der Rechtsherzkatheteruntersuchung unterstreicht.Die Rationale sowie mögliche Auswirkungen der neuen PH-Definition, zu welchen zwischenzeitlich bereits neue Publikationen erschienen sind, möchten wir in diesem Übersichtsartikel diskutieren. Ferner ist ein aktueller Überblick zur nicht-invasiven und invasiven Diagnostik der PH enthalten, in welchem auf den Stellenwert der Methoden für Diagnostik, Differenzialdiagnostik und Prognose sowie weitere Neuerungen der 6. PH-Weltkonferenz eingegangen wird. Ergänzt haben wir einen Abschnitt zum Stellenwert von Belastungsuntersuchungen für das Erkennen und die Verlaufsbeurteilung der PH, welche bei der Diskussion in Nizza und in den nachfolgenden Publikationen zumindest erwähnt, aber nicht ausführlicher besprochen wurden.

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Impact of the New Pulmonary Hypertension Definition on Heart Transplant Outcomes

Cited by 35 publications

References 25 publications

Diagnosis and Management of Pulmonary Hypertension in the Modern Era: Insights from the 6th World Symposium

Diagnosis and Management of Pulmonary Hypertension in the Modern Era: Insights from the 6th World Symposium

Combined pre- and post-capillary pulmonary hypertension: The clinical implications for patients with heart failure

Aktuelle Definition und Diagnostik der pulmonalen Hypertonie

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