The new haemodynamic definition of pulmonary hypertension: evidence prevails, finally!

Hoeper, Marius M.; Humbert, Marc

doi:10.1183/13993003.00038-2019

Cited by 51 publications

(41 citation statements)

References 29 publications

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“…The 2018 6th world PH symposium discussed the revised definition of hemodynamics and lowered the PAP threshold for PH diagnosis from > 25mm Hg to > 20 mm Hg. [19][20][21] This change is expected to enhance the early detection of PHD.…”

Section: Discussionmentioning

confidence: 99%

Mean platelet volume combined red cell distribution width as biomarker of chronic obstructive pulmonary disease with pulmonary heart disease

Bai

Tao

2020

Clinical Respiratory J

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Background and objective Platelet activation, inflammatory reactions and oxidative stress are common pathogenesis of chronic obstructive pulmonary disease (COPD) with pulmonary heart disease (PHD). Mean platelet volume (MPV) and red blood cell distribution width (RDW) form part of the pathomechanisms of these conditions. Here, we investigated whether MPV and RDW can be biomarkers of PHD occurring secondary to COPD. Materials and methods This was a retrospective study on 229 participants with COPD. Among them, 69 had PHD. Complete blood count (CBC), blood gas analysis, pulmonary function tests and echocardiography were analyzed. Results MPV and RDW‐standard deviation (RDW‐SD) were significantly higher in patients with PHD than in patients without PHD (P ≤ 0.001). MPV and RDW‐SD were positively correlated with pulmonary artery pressure (PAP) and the size of the right ventricle (P ≤ 0.05). Multivariate regression analysis showed that the risk of PHD increased 3‐fold per unit rise in MPV (OR = 2.901, P ≤ 0.001). We observed that the risk of PHD increased 1.5 times per unit rise in RDW‐SD (OR = 1.371, P ≤ 0.001).The AUC of ROC curve for the combined MPV and RDW‐SD in predicting PHD among COPD patients was 0.900 (95％CI: 0.846‐0．954, P ≤ 0.001), with a sensitivity of 76.8% and a specificity of 99.4%. Conclusions Both MPV and RDW‐SD were significantly elevated and correlated with disease severity in COPD patients with PHD. A combination of these two parameters presents an effective biomarker of PHD.

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Section: Discussionmentioning

confidence: 99%

Mean platelet volume combined red cell distribution width as biomarker of chronic obstructive pulmonary disease with pulmonary heart disease

Bai

Tao

2020

Clinical Respiratory J

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“…In systemic sclerosis, incorporating TTE with pulmonary function testing and biomarkers may have a higher predictive value in asymptomatic patients than echocardiography alone 27,28 . This may be important because even those patients with relatively mild PH require more frequent hospitalization and suffer shortened survival 29,30 . Future studies of PH in MPN should clearly define prospective criteria for screening, risk stratification, and criteria for RHC confirmation of PH.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors for Pulmonary Hypertension associated with chronic Myeloproliferative Neoplasms

Ferrari

Scandura

Masciulli

et al. 2020

European J of Haematology

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Objectives Pulmonary hypertension (PH) is commonly reported in Philadelphia‐chromosome negative myeloproliferative neoplasms (MPNs) including polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF). PH may be diagnosed directly by right heart catheterization (RHC) or estimated by transthoracic echocardiography (TTE). Survival is shortened by PH but despite the potential significance of PH to management and prognosis of MPN, estimates of its prevalence in MPNs vary and risk factors for the condition are poorly established. We performed a systematic review and meta‐analysis of available studies to fill this void. Methods We searched EMBASE, MEDLINE, and Clinicaltrials.gov for the terms “pulmonary hypertension,” “myeloproliferative disorders,” “polycythemia vera,” “essential thrombocythemia,” and “myelofibrosis.” We restricted analysis to the 1999‐2019 window to improve uniformity of MPN diagnostic criteria. We retrieved 221 records and, after abstract and full‐text screening, identified 17 papers meeting criteria for inclusion in our meta‐analysis. A modified Newcastle‐Ottawa scale was used to assess quality. Results Results for 935 patients were available, 309 of these having PH (33%). Using logistic mixed‐effect regression, we found that diagnosis mode (RHC vs TTE) and MPN duration influenced PH prevalence. Studies employing predominantly TTE yielded prevalence estimates ~5‐fold higher than those using RHC (35% vs 7.2%). We identified MF and duration of MPN as significant risk factors for development of PH. Conclusions Prevalence of PH in MPNs is poorly understood with estimates ranging from 3.8% to 58%. Patients with MF and longer duration of disease seem at particularly high risk and should be carefully monitored for PH.

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“…The pros and cons of the proposed revision to the definition of PH have been debated in the literature 7 , 8 . In our opinion, the proposed threshold of an mPAP of >20 mmHg is the correct threshold to use for defining PH, and the greater emphasis given to elevated PVR for detecting pulmonary vascular disease is a necessary paradigm shift.…”

Section: Introductionmentioning

confidence: 99%

“…In our opinion, the proposed threshold of an mPAP of >20 mmHg is the correct threshold to use for defining PH, and the greater emphasis given to elevated PVR for detecting pulmonary vascular disease is a necessary paradigm shift. The clinical justification for the suggested change has been described in detail elsewhere, 1 , 7 yet as the proposal is relatively recent and has not yet been adopted in clinical practice, there are limited data on how it will affect clinical management. Therefore, in this article, we will discuss the potential effect of this revised definition on patient management, based on our clinical experience.…”

Section: Introductionmentioning

confidence: 99%

The revised definition of pulmonary hypertension: exploring the impact on patient management

Simonneau

Hoeper

2019

European Heart Journal Supplements

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At the 6th World Symposium on Pulmonary Hypertension (PH), it was proposed that the mean pulmonary arterial pressure (mPAP) threshold used to define PH should be lowered from ≥25 mmHg to >20 mmHg. The rationale for this change is that the ≥25 mmHg threshold is arbitrary, whereas the revised threshold is based on scientific evidence. For the definition of all forms of pre-capillary PH, the inclusion of a pulmonary vascular resistance (PVR) ≥3 Wood Units was also proposed, placing greater emphasis on an elevated PVR to identify pulmonary vascular disease. Here, we discuss the possible impact of the revised definition of PH on future clinical management. This change may facilitate earlier PH detection, particularly in at-risk patient groups that are already undergoing screening programmes, e.g. those with systemic sclerosis or mutations associated with PH. As an mPAP above the upper limit of normal (>20 mmHg) but <25 mmHg is associated with increased risk of morbidity and mortality compared with a normal mPAP, early identification of patients in this group is important to enable close monitoring and timely treatment initiation once clinically indicated. Treatments currently approved for PH are not necessarily suitable for patients with an mPAP 21–24 mmHg, as the management of this group has not been widely examined. The revised definition may facilitate inclusion of these patients in prospective trials, allowing the evaluation of appropriate management strategies.

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The new haemodynamic definition of pulmonary hypertension: evidence prevails, finally!

Cited by 51 publications

References 29 publications

Mean platelet volume combined red cell distribution width as biomarker of chronic obstructive pulmonary disease with pulmonary heart disease

Mean platelet volume combined red cell distribution width as biomarker of chronic obstructive pulmonary disease with pulmonary heart disease

Prevalence and risk factors for Pulmonary Hypertension associated with chronic Myeloproliferative Neoplasms

The revised definition of pulmonary hypertension: exploring the impact on patient management

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