2022 ESC/ERS guidelines on the diagnostics and treatment of pulmonary hypertension : Afocussed review

Abstract

Pulmonary hypertension (PH) is ahemodynamic state that can be caused by avariety of underlying conditions. The pathophysiology is complex and can involve several organ systems, requiring amultidisciplinary approach to differential diagnostics and management. This review article provides acomprehensive overview of the most important changes in the updated 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines on the diagnostics and treatment of pulmonary hypertension, as compared to the previous 2015 version. A special focus is on (i)updated hemodynamic definitions of PH, including general definition, precapillary vs. postcapillary PH, isolated postcapillary PH (IpcPH), combined postcapillary and precapillary PH (CpcPH), (ii)the clinical presentation and classification of PH, (iii)the diagnostic approach as well as (iv)specific aspects of pulmonary arterial hypertension (PAH, group1), including risk assessment, treatment and PAH with comorbidities, PH associated with left heart (group2) or lung disease (group3), and chronic thromboembolic pulmonary hypertension (CTEPH, group4). Regarding the latter, the specific diagnostic algorithm and the multimodal approach to treatment are presented. Finally, for each of the PH groups, clinically relevant aspects and innovations are briefly and concisely presented.