[Dana Point: what is new in the diagnosis of pulmonary hypertension?].
The hemodynamic definition of pulmonary hypertension (PH) has not been evidence-based. Normal individuals have a pulmonary pressure of about 14 mm Hg. The respective normal range is up to 20 mm Hg. It was decided in Dana Point 2008 to introduce new thresholds for mean pulmonary arterial pressure with < 21 mm Hg = normal, 21 - 25 mm Hg = borderline, and > 25 mm Hg = manifest PH. Correspondingly, echocardiographic systolic tricuspid regurgitant velocity thresholds will be < 2.5 m/s = normal, 2.5 - 2.8 = borderline, > 2.8 m/s = manifest PH. Confirmation by right heart catheterization is mandatory as many false positive readings and patients with undetected diastolic filling disturbance can be expected, based on current literature. During exercise, PA pressure is strongly age-dependent. Therefore exercise values were left out of the definition. Cardiac magnetic resonance imaging (MRI) is expected to gain importance for routine examinations in the next years, although currently right heart catheterization regains territory. Genetic analysis of BMPR2 gene represents an important option for patients with idiopathic PAH and their relatives. However, it is not suitable for screening in the general population. Follow-up examinations in patients with targeted therapy are very important for the definition of specific therapy goals in order to improve prognosis. Future IN VIVO tests of vessel properties and right heart function could improve our understanding and the development of new therapies.
Olschewski
H
H
Klinische Abteilung für Lungenkrankheiten, Universitätsklinik für Innere Medizin, Graz. horst.olschewski@meduni-graz.at
D052006:Bone Morphogenetic Protein Receptors, Type II / Q000235:genetics; D006328:Cardiac Catheterization; D004452:Echocardiography; D005080:Exercise Test; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012016:Reference Values
C498218:BMPR2 protein, human; D052006:Bone Morphogenetic Protein Receptors, Type II