Updated definition of exercise pulmonary hypertension

Abstract

In the recently published European Society of Cardiology/European Respiratory Society guidelines on the diagnosis and treatment of pulmonary hypertension (PH) the haemodynamic definitions of PH were updated and a new definition for exercise PH was introduced. Accordingly, exercise PH is characterised by a mean pulmonary arterial pressure/cardiac output (CO) slope >3 Wood units (WU) from rest to exercise. This threshold is supported by several studies demonstrating prognostic and diagnostic relevance of exercise haemodynamics in various patient cohorts. From a differential diagnostic point of view, an elevated pulmonary arterial wedge pressure/CO slope >2 WU may be suitable to identify post-capillary causes of exercise PH. Right heart catheterisation remains the gold standard to assess pulmonary haemodynamics both at rest and exercise. In this review, we discuss the evidence that led to the reintroduction of exercise PH in the PH definitions.

Updated Clinical Classification and Hemodynamic Definitions of Pulmonary Hypertension and Its Clinical Implications

“…The next major development was the publication of a systematic review discussing the flow-dependant changes in exercise hemodynamics [ 32 ]. By reviewing 250 patients with exercise hemodynamics, the authors were able to identify linear relationship between the mPAP and CO. Two important observations were that the mPAP/CO slope was positive and that there was a significant increase with age [ 37 ]. Specifically, the mean values were 0.8 ± 0.4 mmHg/L/min in patients around age 30, 1.6 ± 0.2 mmHg/L/min around age 50, and 2.4 ± 0.5 mmHg/L/min around age 70 with upper limits of normal of 1.6, 2.1, and 3.3 mmHg/L/min respectively.…”