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Cardiopulmonary Hemodynamics in Pulmonary Hypertension and Heart Failure

2020; Elsevier BV; Volume: 76; Issue: 22 Linguagem: Inglês

10.1016/j.jacc.2020.10.007

1558-3597

Bradley A. Maron, Gábor Kovács, Anjali Vaidya, Deepak L. Bhatt, Rick A. Nishimura, Susanna Mak, Marco Guazzi, Ryan J. Tedford,

Cardiovascular Issues in Pregnancy

Pulmonary hypertension (PH) is an independent risk factor for adverse clinical outcome, particularly in left heart disease (LHD) patients. Recent advances have clarified the mean pulmonary artery pressure (mPAP) range that is above normal and is associated with clinical events, including mortality. This progress has for the first time resulted in a new clinical definition of PH that is evidenced-based, is inclusive of mPAP >20 mm Hg, and emphasizes early diagnosis. Additionally, pulmonary vascular resistance (PVR) 2.2 to 3.0 WU, considered previously to be normal, appears to associate with elevated clinical risk. A revised approach to classifying PH patients as pre-capillary, isolated post-capillary, or combined pre-/post-capillary PH now guides point-of-care diagnosis, risk stratification, and treatment. Exercise hemodynamic or confrontational fluid challenge studies may also aid decision-making for patients with PH-LHD or otherwise unexplained dyspnea. This collective progress in pulmonary vascular and heart failure medicine reinforces the critical importance of accurate hemodynamic assessment.