Diagnosing post-capillary hypertension in patients with left heart disease: impact of new guidelines.
Guidelines
Left heart disease
Post-capillary pulmonary hypertension
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
05 Sep 2023
05 Sep 2023
Historique:
received:
20
05
2023
accepted:
17
08
2023
medline:
5
9
2023
pubmed:
5
9
2023
entrez:
5
9
2023
Statut:
aheadofprint
Résumé
In 2022, the definition of pulmonary hypertension (PH) in the presence of left heart disease was updated according to the new joint guidelines of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). The impact of the new ESC/ERS definition on the prevalence of post-capillary PH (pc-PH) and its subgroups of isolated post-capillary (Ipc-PH) and combined pre- and post-capillary PH (Cpc-PH) in patients with left heart disease is unclear. We retrospectively identified N = 242 patients with left heart disease with available data on right heart catheterisation (RHC) and cardiac magnetic resonance imaging (CMR). The proportion of pc-PH and its subgroups was calculated according to the old and new ESC/ERS PH definition. As the old definition did not allow the exact allocation of all patients with pc-PH into a respective subgroup, unclassifiable patients (Upc-PH) were regarded separately. Seventy-six out of 242 patients had pc-PH according to the new ESC/ERS definitions, with 72 of these patients also meeting the criteria of the old definition. Using the old definition, 50 patients were diagnosed with Ipc-PH, 4 with Cpc-PH, and 18 with Upc-PH. Applying the new definition, Ipc-PH was diagnosed in 35 patients (4 newly), and Cpc-PH in 41 patients. No CMR parameter allowed differentiating between Ipc-PH and Cpc-PH, regardless of which guideline version was used. Applying the new ESC/ERS 2022 guideline definitions mildly increased the proportion of patients diagnosed with pc-PH (+ 5.5%) but markedly increased Cpc-PH diagnoses. This effect was driven by the allocation of patients with formerly unclassifiable forms of post-capillary PH to the Cpc-PH subgroup and a significant shift of patients from the Ipc-PH to the Cpc-PH subgroup. Distribution of post-capillary pulmonary hypertension (pc-PH) subgroups according to the European Society of Cardiology/European Respiratory Society (ESC/ERS) PH guidelines from 2015 and 2022 in N = 242 patients with left heart disease.
Sections du résumé
BACKGROUND
BACKGROUND
In 2022, the definition of pulmonary hypertension (PH) in the presence of left heart disease was updated according to the new joint guidelines of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). The impact of the new ESC/ERS definition on the prevalence of post-capillary PH (pc-PH) and its subgroups of isolated post-capillary (Ipc-PH) and combined pre- and post-capillary PH (Cpc-PH) in patients with left heart disease is unclear.
METHODS
METHODS
We retrospectively identified N = 242 patients with left heart disease with available data on right heart catheterisation (RHC) and cardiac magnetic resonance imaging (CMR). The proportion of pc-PH and its subgroups was calculated according to the old and new ESC/ERS PH definition. As the old definition did not allow the exact allocation of all patients with pc-PH into a respective subgroup, unclassifiable patients (Upc-PH) were regarded separately.
RESULTS
RESULTS
Seventy-six out of 242 patients had pc-PH according to the new ESC/ERS definitions, with 72 of these patients also meeting the criteria of the old definition. Using the old definition, 50 patients were diagnosed with Ipc-PH, 4 with Cpc-PH, and 18 with Upc-PH. Applying the new definition, Ipc-PH was diagnosed in 35 patients (4 newly), and Cpc-PH in 41 patients. No CMR parameter allowed differentiating between Ipc-PH and Cpc-PH, regardless of which guideline version was used.
CONCLUSION
CONCLUSIONS
Applying the new ESC/ERS 2022 guideline definitions mildly increased the proportion of patients diagnosed with pc-PH (+ 5.5%) but markedly increased Cpc-PH diagnoses. This effect was driven by the allocation of patients with formerly unclassifiable forms of post-capillary PH to the Cpc-PH subgroup and a significant shift of patients from the Ipc-PH to the Cpc-PH subgroup. Distribution of post-capillary pulmonary hypertension (pc-PH) subgroups according to the European Society of Cardiology/European Respiratory Society (ESC/ERS) PH guidelines from 2015 and 2022 in N = 242 patients with left heart disease.
Identifiants
pubmed: 37668664
doi: 10.1007/s00392-023-02290-5
pii: 10.1007/s00392-023-02290-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Open Access funding enabled and organized by Projekt DEAL. Bundesministerium für Bildung und Forschung
ID : 01EO1504
Organisme : Julius-Maximilians-Universität Würzburg
ID : Publication Fund
Informations de copyright
© 2023. The Author(s).
Références
Humbert M, Kovacs G, Hoeper MM, Badagliacca R, Berger RMF, Brida M, Carlsen J, Coats AJS, Escribano-Subias P, Ferrari P, Ferreira DS, Ghofrani HA, Giannakoulas G, Kiely DG, Mayer E, Meszaros G, Nagavci B, Olsson KM, Pepke-Zaba J, Quint JK, Radegran G, Simonneau G, Sitbon O, Tonia T, Toshner M, Vachiery JL, Vonk Noordegraaf A, Delcroix M, Rosenkranz S, Group EESD (2022) 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 43(38):3618–3731. https://doi.org/10.1093/eurheartj/ehac237
doi: 10.1093/eurheartj/ehac237
pubmed: 36017548
Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, Simonneau G, Peacock A, Vonk Noordegraaf A, Beghetti M, Ghofrani A, Gomez Sanchez MA, Hansmann G, Klepetko W, Lancellotti P, Matucci M, McDonagh T, Pierard LA, Trindade PT, Zompatori M, Hoeper M, Aboyans V, Vaz Carneiro A, Achenbach S, Agewall S, Allanore Y, Asteggiano R, Paolo Badano L, Albert Barbera J, Bouvaist H, Bueno H, Byrne RA, Carerj S, Castro G, Erol C, Falk V, Funck-Brentano C, Gorenflo M, Granton J, Iung B, Kiely DG, Kirchhof P, Kjellstrom B, Landmesser U, Lekakis J, Lionis C, Lip GY, Orfanos SE, Park MH, Piepoli MF, Ponikowski P, Revel MP, Rigau D, Rosenkranz S, Voller H, Luis Zamorano J (2016) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 37(1):67–119. https://doi.org/10.1093/eurheartj/ehv317
doi: 10.1093/eurheartj/ehv317
pubmed: 26320113
Vachiery JL, Adir Y, Barbera JA, Champion H, Coghlan JG, Cottin V, De Marco T, Galie N, Ghio S, Gibbs JS, Martinez F, Semigran M, Simonneau G, Wells A, Seeger W (2013) Pulmonary hypertension due to left heart diseases. J Am Coll Cardiol 62(25 Suppl):D100-108. https://doi.org/10.1016/j.jacc.2013.10.033
doi: 10.1016/j.jacc.2013.10.033
pubmed: 24355634
Rosenkranz S, Lang IM, Blindt R, Bonderman D, Bruch L, Diller GP, Felgendreher R, Gerges C, Hohenforst-Schmidt W, Holt S, Jung C, Kindermann I, Kramer T, Kubler WM, Mitrovic V, Riedel A, Rieth A, Schmeisser A, Wachter R, Weil J, Opitz CF (2018) Pulmonary hypertension associated with left heart disease: updated recommendations of the Cologne Consensus Conference 2018. Int J Cardiol 272S:53–62. https://doi.org/10.1016/j.ijcard.2018.08.080
doi: 10.1016/j.ijcard.2018.08.080
pubmed: 30527996
Gerges M, Gerges C, Lang IM (2016) How to define pulmonary hypertension due to left heart disease. Eur Respir J 48(2):553–555. https://doi.org/10.1183/13993003.00432-2016
doi: 10.1183/13993003.00432-2016
pubmed: 27174881
Galie N, Manes A, Palazzini M (2016) The difficult diagnosis of pulmonary vascular disease in heart failure. Eur Respir J 48(2):311–314. https://doi.org/10.1183/13993003.00854-2016
doi: 10.1183/13993003.00854-2016
pubmed: 27478188
Vachiery JL, Tedford RJ, Rosenkranz S, Palazzini M, Lang I, Guazzi M, Coghlan G, Chazova I, De Marco T (2019) Pulmonary hypertension due to left heart disease. Eur Respir J. https://doi.org/10.1183/13993003.01897-2018
doi: 10.1183/13993003.01897-2018
pubmed: 31558657
pmcid: 6351334
Simonneau G, Hoeper MM (2019) The revised definition of pulmonary hypertension: exploring the impact on patient management. Eur Heart J Suppl 21(Suppl K):K4–K8. https://doi.org/10.1093/eurheartj/suz211
doi: 10.1093/eurheartj/suz211
pubmed: 31857795
pmcid: 6915058
Kaspar M, Fette G, Guder G, Seidlmayer L, Ertl M, Dietrich G, Greger H, Puppe F, Stork S (2018) Underestimated prevalence of heart failure in hospital inpatients: a comparison of ICD codes and discharge letter information. Clin Res Cardiol 107(9):778–787. https://doi.org/10.1007/s00392-018-1245-z
doi: 10.1007/s00392-018-1245-z
pubmed: 29667017
pmcid: 6105250
Argueta EE, Paniagua D (2019) Thermodilution cardiac output: a concept over 250 years in the making. Cardiol Rev 27(3):138–144. https://doi.org/10.1097/CRD.0000000000000223
doi: 10.1097/CRD.0000000000000223
pubmed: 30946701
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270. https://doi.org/10.1093/ehjci/jev014
doi: 10.1093/ehjci/jev014
pubmed: 25712077
Kramer CM, Barkhausen J, Bucciarelli-Ducci C, Flamm SD, Kim RJ, Nagel E (2020) Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update. J Cardiovasc Magn Reson 22(1):17. https://doi.org/10.1186/s12968-020-00607-1
doi: 10.1186/s12968-020-00607-1
pubmed: 32089132
pmcid: 7038611
Vanderpool RR, Pinsky MR, Naeije R, Deible C, Kosaraju V, Bunner C, Mathier MA, Lacomis J, Champion HC, Simon MA (2015) RV-pulmonary arterial coupling predicts outcome in patients referred for pulmonary hypertension. Heart 101(1):37–43. https://doi.org/10.1136/heartjnl-2014-306142
doi: 10.1136/heartjnl-2014-306142
pubmed: 25214501
Burrage MK, Hundertmark M, Valkovic L, Watson WD, Rayner J, Sabharwal N, Ferreira VM, Neubauer S, Miller JJ, Rider OJ, Lewis AJM (2021) Energetic basis for exercise-induced pulmonary congestion in heart failure with preserved ejection fraction. Circulation 144(21):1664–1678. https://doi.org/10.1161/circulationaha.121.054858
doi: 10.1161/circulationaha.121.054858
pubmed: 34743560
pmcid: 8601674
Rosenkranz S, Preston IR (2015) Right heart catheterisation: best practice and pitfalls in pulmonary hypertension. Eur Respir Rev 24(138):642–652. https://doi.org/10.1183/16000617.0062-2015
doi: 10.1183/16000617.0062-2015
pubmed: 26621978
pmcid: 9487613
Dubois D, Dubois EF (1989) Nutrition metabolism classic—a formula to estimate the approximate surface-area if height and weight be known (Reprinted from Archives Internal Medicine, Vol 17, Pg 863, 1916). Nutrition 5(5):303–311
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, Burri H, Butler J, Celutkiene J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A, Group ESCSD (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42(36):3599–3726. https://doi.org/10.1093/eurheartj/ehab368
doi: 10.1093/eurheartj/ehab368
pubmed: 34447992
Pieske B, Tschope C, de Boer RA, Fraser AG, Anker SD, Donal E, Edelmann F, Fu M, Guazzi M, Lam CSP, Lancellotti P, Melenovsky V, Morris DA, Nagel E, Pieske-Kraigher E, Ponikowski P, Solomon SD, Vasan RS, Rutten FH, Voors AA, Ruschitzka F, Paulus WJ, Seferovic P, Filippatos G (2020) How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur J Heart Fail 22(3):391–412. https://doi.org/10.1002/ejhf.1741
doi: 10.1002/ejhf.1741
pubmed: 32133741
Galie N, McLaughlin VV, Rubin LJ, Simonneau G (2019) An overview of the 6th World Symposium on Pulmonary Hypertension. Eur Respir J. https://doi.org/10.1183/13993003.02148-2018
doi: 10.1183/13993003.02148-2018
pubmed: 30552088
pmcid: 6351343
Simonneau G, Montani D, Celermajer DS, Denton CP, Gatzoulis MA, Krowka M, Williams PG, Souza R (2019) Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. https://doi.org/10.1183/13993003.01913-2018
doi: 10.1183/13993003.01913-2018
pubmed: 31649145
pmcid: 6853610
Kovacs G, Berghold A, Scheidl S, Olschewski H (2009) Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review. Eur Respir J 34(4):888–894. https://doi.org/10.1183/09031936.00145608
doi: 10.1183/09031936.00145608
pubmed: 19324955
Tampakakis E, Leary PJ, Selby VN, De Marco T, Cappola TP, Felker GM, Russell SD, Kasper EK, Tedford RJ (2015) The diastolic pulmonary gradient does not predict survival in patients with pulmonary hypertension due to left heart disease. JACC Heart Fail 3(1):9–16. https://doi.org/10.1016/j.jchf.2014.07.010
doi: 10.1016/j.jchf.2014.07.010
pubmed: 25453535
Aronson D, Hardak E, Burger AJ (2019) Hemodynamics of the diastolic pressure gradients in acute heart failure: implications for the diagnosis of pre-capillary pulmonary hypertension in left heart disease. Pulm Circ 9(1):2045894018815438. https://doi.org/10.1177/2045894018815438
doi: 10.1177/2045894018815438
pubmed: 30419797
Riccardi M, Pagnesi M, Sciatti E, Lombardi CM, Inciardi RM, Metra M, Vizzardi E (2022) Combined pre- and post-capillary pulmonary hypertension in left heart disease. Heart Fail Rev. https://doi.org/10.1007/s10741-022-10251-9
doi: 10.1007/s10741-022-10251-9
pubmed: 36402928
pmcid: 9941240
Maron BA, Brittain EL, Hess E, Waldo SW, Baron AE, Huang S, Goldstein RH, Assad T, Wertheim BM, Alba GA, Leopold JA, Olschewski H, Galie N, Simonneau G, Kovacs G, Tedford RJ, Humbert M, Choudhary G (2020) Pulmonary vascular resistance and clinical outcomes in patients with pulmonary hypertension: a retrospective cohort study. Lancet Respir Med 8(9):873–884. https://doi.org/10.1016/S2213-2600(20)30317-9
doi: 10.1016/S2213-2600(20)30317-9
pubmed: 32730752
pmcid: 8219057
Kovacs G, Olschewski A, Berghold A, Olschewski H (2012) Pulmonary vascular resistances during exercise in normal subjects: a systematic review. Eur Respir J 39(2):319–328. https://doi.org/10.1183/09031936.00008611
doi: 10.1183/09031936.00008611
pubmed: 21885394
Pfeuffer-Jovic E, Weiner S, Wilkens H, Schmitt D, Frantz S, Held M (2021) Impact of the new definition of pulmonary hypertension according to world symposium of pulmonary hypertension 2018 on diagnosis of post-capillary pulmonary hypertension. Int J Cardiol 335:105–110. https://doi.org/10.1016/j.ijcard.2021.04.006
doi: 10.1016/j.ijcard.2021.04.006
pubmed: 33823213
Bauersachs J, Olsson KM (2022) Targeting pulmonary hypertension in patients with heart failure and preserved ejection fraction: rather static than DYNAMIC development? Eur Heart J. https://doi.org/10.1093/eurheartj/ehac387
doi: 10.1093/eurheartj/ehac387
pubmed: 35909260
pmcid: 9336586
Cao JY, Wales KM, Cordina R, Lau EMT, Celermajer DS (2018) Pulmonary vasodilator therapies are of no benefit in pulmonary hypertension due to left heart disease: a meta-analysis. Int J Cardiol 273:213–220. https://doi.org/10.1016/j.ijcard.2018.09.043
doi: 10.1016/j.ijcard.2018.09.043
pubmed: 30224253
Magne J, Pibarot P, Sengupta PP, Donal E, Rosenhek R, Lancellotti P (2015) Pulmonary hypertension in valvular disease: a comprehensive review on pathophysiology to therapy from the HAVEC Group. JACC Cardiovasc Imaging 8(1):83–99. https://doi.org/10.1016/j.jcmg.2014.12.003
doi: 10.1016/j.jcmg.2014.12.003
pubmed: 25592699
Bermejo J, Yotti R, Garcia-Orta R, Sanchez-Fernandez PL, Castano M, Segovia-Cubero J, Escribano-Subias P, San Roman JA, Borras X, Alonso-Gomez A, Botas J, Crespo-Leiro MG, Velasco S, Bayes-Genis A, Lopez A, Munoz-Aguilera R, de Teresa E, Gonzalez-Juanatey JR, Evangelista A, Mombiela T, Gonzalez-Mansilla A, Elizaga J, Martin-Moreiras J, Gonzalez-Santos JM, Moreno-Escobar E, Fernandez-Aviles F (2018) Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial. Eur Heart J 39(15):1255–1264. https://doi.org/10.1093/eurheartj/ehx700
doi: 10.1093/eurheartj/ehx700
pubmed: 29281101
Armstrong PW, Pieske B, Anstrom KJ, Ezekowitz J, Hernandez AF, Butler J, Lam CSP, Ponikowski P, Voors AA, Jia G, McNulty SE, Patel MJ, Roessig L, Koglin J, O’Connor CM, Group VS (2020) Vericiguat in patients with heart failure and reduced ejection fraction. N Engl J Med 382(20):1883–1893. https://doi.org/10.1056/NEJMoa1915928
doi: 10.1056/NEJMoa1915928
pubmed: 32222134
Lteif C, Ataya A, Duarte JD (2021) Therapeutic challenges and emerging treatment targets for pulmonary hypertension in left heart disease. J Am Heart Assoc 10(11):e020633. https://doi.org/10.1161/JAHA.120.020633
doi: 10.1161/JAHA.120.020633
pubmed: 34032129
pmcid: 8483544
Rosenkranz S, Delcroix M, Giannakoulas G, Hoeper MM, Kovacs G, Humbert M (2023) The ‘Ten Commandments’ of the 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 44(10):792–793. https://doi.org/10.1093/eurheartj/ehad018
doi: 10.1093/eurheartj/ehad018
pubmed: 36723982
Callan P, Clark AL (2016) Right heart catheterisation: indications and interpretation. Heart 102(2):147–157. https://doi.org/10.1136/heartjnl-2015-307786
doi: 10.1136/heartjnl-2015-307786
pubmed: 26701966