CHEST Guidelines-POINT--Should-the-New-Definition-of-PH-Be-the-Clin

POINT--Should-the-New-Definition-of-PH-Be-the-Clin

Pdf Summary

The debate on redefining pulmonary hypertension (PH) in clinical practice hinges on updating the mean pulmonary artery pressure (mPAP) threshold. Historically, PH was defined by mPAP ≥ 25 mm Hg, but recent insights propose lowering this threshold to 20 mm Hg based on empirical data showing that pressures above this level are abnormal and associated with increased clinical risk. Advocates for this change, like Dr. Bradley A. Maron, argue it aligns with empirical findings that mPAP >19 mm Hg increases mortality risk and often indicates compromised cardiovascular function. They claim this new definition could lead to earlier diagnosis and interventions for PH, allowing for modified progression, particularly in mild cases that might otherwise go unnoticed.<br /><br />Dr. Robert P. Frantz, however, cautions against rushing the new definition into practice. He points out that lowering the mPAP threshold could lead to excessive diagnostic testing and unnecessary right heart catheterizations, particularly in cases where mild errors in non-invasive estimations (like those from echocardiography) could lead to false positives. This, Frantz argues, would impose additional costs and potential psychological distress on patients without guaranteeing improved outcomes.<br /><br />While preliminary evidence supports the association between mild PH and increased risk, Frantz emphasizes that current testing lacks a reliable bioassay to accurately distinguish between different PH pathologies. Without clear evidence demonstrating benefits from identifying or treating conditions under the new mPAP threshold, Frantz urges caution, particularly to avoid overtreatment and misdiagnosis.<br /><br />Overall, the dialogue highlights a tension between leveraging new data for proactive healthcare versus the risks of changing diagnostic thresholds prematurely without comprehensive understanding and infrastructure to manage these changes effectively.

Keywords

pulmonary hypertension

mean pulmonary artery pressure

mPAP threshold

cardiovascular function

early diagnosis

right heart catheterization

false positives

overtreatment

diagnostic thresholds

healthcare risks