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Misclassification-of-Pulmonary-Hypertension-With-C
Misclassification-of-Pulmonary-Hypertension-With-C
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The letter to the editor discusses the latest hemodynamic criteria for diagnosing pulmonary hypertension (PH) within the context of heart failure patients. PH is recognized as a multifaceted disorder associated with high morbidity and mortality, categorized by both clinical origin and hemodynamic characteristics, and its diagnostic criteria have evolved over time. Key updates include the reduction of mean pulmonary artery pressure for PH diagnosis from 25 mm Hg to 20 mm Hg, and a decrease in the pulmonary vascular resistance (PVR) threshold from 3 Wood units (WU) to 2 WU for classification purposes.<br /><br />Study findings from the Hemodynamic Frontiers in Heart Failure Registry show that 85.3% of the heart failure patients in the registry fit the PH criteria with a majority presenting postcapillary or combined PH hemodynamics. Notably, 16% of patients were classified as having precapillary PH, despite their profiles suggesting postcapillary or combined PH.<br /><br />The letter highlights that the current criteria pose risks of misclassification because symptoms overlap between PH subtypes when relying solely on PVR and pulmonary capillary wedge pressure (PCWP) values. Moreover, in left-sided heart disease, conditions such as PH can appear in different hemodynamic states, complicating accurate classification. The absence of tests like exercise testing or fluid challenge during assessments further contributes to potential misclassifications.<br /><br />The authors argue that while recent criteria aim for early PH diagnosis, the overlap between precapillary, postcapillary, and combined PH types may lead to incorrect patient categorization. This emphasizes the necessity of interpreting right heart catheterization results within the broader clinical context, particularly considering patients with heart failure are prone to misclassifications resulting from isolated hemodynamic measurements like PVR and PCWP.
Keywords
pulmonary hypertension
hemodynamic criteria
heart failure
mean pulmonary artery pressure
pulmonary vascular resistance
precapillary PH
postcapillary PH
combined PH
right heart catheterization
misclassification
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