New criteria for diagnosis of pulmonary arterial hypertension: pros and cons

Abstract

The updated 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension approved new criteria for diagnosis of pulmonary hypertension (PH). In this review we present the data from modern studies proving the expediency of changing the threshold values of hemodynamic parameters measured by right heart catheterization (RHC) and echocardiography for the diagnosis of PH, the importance of introduction the definition «exercise PH» into clinical practice.New haemodynamic definition of pulmonary arterial hypertension: mean pulmonary arterial pressure (mPAP) > 20 mmHg, pulmonary arterial wedge pressure < 15 mmHg, pulmonary vascular resistance (PVR) > 2 Wood units, measured by RHC at rest. Diagnostic levels of systolic pulmonary arterial pressure and tricuspid regurgitation velocity measured by echocardiography stay the same, but it is important to combine them with a number of additional echocardiographic signs of PH.Promising direction for early diagnosis of PH is RHC during exercise in addition to studies at rest. Nowadays there are no generally accepted diagnostic criteria for exercise PH. Some studies propose the following threshold values of exercise PH: mPAP > 30 mmHg and PVR > 3 Wood units during exercise.