title: The Diagnostic Challenge of Group 2 Pulmonary Hypertension.
abstract: Pulmonary hypertension (PH) secondary to left heart diseases associated with an increased pulmonary venous pressure is the second of a total of five groups recognized in the classification of PH. Group 2 PH is the commonest form of PH, and is associated with high morbidity and mortality. The diagnosis of group 2 PH relies on a clinical probability assessment in which echocardiography plays a major role, eventually followed by the invasive measurements of a mean pulmonary artery pressure (mPAP) ≥25mmHg and a wedged PAP (PAWP) >15mmHg. This combination of mPAP and PAWP defines "post-capillary PH" (pcPH). Post-capillary PH is most often associated with a diastolic pressure gradient (DPG) or gradient between diastolic PAP and PAWP <7mmHg and/or a pulmonary vascular resistance (PVR) ≤3Wood units (WU), and is called isolated pcPH (IpcPH). Postcapillary PH with a DPG ≥7mmHg and/or a PVR >3WU is then combined pre- and postcapillary PH (CpcPH). Post-capillary PH is associated with a decreased survival in proportion to increased PAP and decreased right ventricular (RV) ejection fraction. CpcPH occurs in 12-13% of patients with pcPH. CpcPH is associated with pulmonary vascular remodeling and altered RV-arterial coupling. The prognosis of CpcPH is poor.
authors.affiliation: Department of Cardiology, Erasme Hospital, Free University of Brussels, Brussels, Belgium. Electronic address: rnaeije@ulb.ac.be.
authors.forename: Robert
authors.initials: R
authors.lastname: Naeije
authors.affiliation: Department of Cardiology, Second University of Naples - Monaldi Hospital, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: D'Alto
mesh_terms: D006328:Cardiac Catheterization; D004452:Echocardiography; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D011379:Prognosis; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D014655:Vascular Resistance / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology
keywords: Diastolic pressure gradient; Echocardiography; Heart failure; Postcapillary pulmonary hypertension; Pulmonary hypertension; Pulmonary vascular resistance; Transpulmonary pressure gradient