Classification of Pulmonary Hypertension
Introduction
Pulmonary hypertension (PH) is a condition of many causes in which there is an elevation in pulmonary artery pressure (PAP) that results from an increase in:
- 1.
Resistance to blood flow within the pulmonary arteries (ie, pulmonary vascular resistance [PVR])
- 2.
Pulmonary blood flow
- 3.
Pulmonary venous pressure from left-sided heart failure (LHF)
- 4.
A combination of any of these 3 elements.
There is growing interest in PH among many medical specialists including cardiologists, pulmonologists, and rheumatologists, likely because of the current availability of specific drugs approved to treat a group of rare conditions defined as pulmonary arterial hypertension (PAH). The similarity between the terms “pulmonary hypertension” and “pulmonary arterial hypertension” has led to confusion and ambiguity in both clinical practice and the medical literature. Therefore, it is important to clarify the different hemodynamic definitions and the clinical classification of PH that, along with a complete diagnostic evaluation, lead to a final clinical diagnosis. The proper clinical diagnosis of PH is important because management of PH is dependent upon the underlying etiology and therapies that are effective in treating PAH may be detrimental when used inappropriately to treat other causes of PH.
Section snippets
Hemodynamic classification of pulmonary hypertension
PH is defined hemodynamically by invasive right heart catheterization (RHC) as a mean pulmonary artery pressure (mPAP) greater than 25 mm Hg. Formerly, PH was also diagnosed if the mPAP reached greater than 30 mm Hg during exercise; however, the exercise criterion was eliminated during the fourth World Symposium on PH because it was not supported by published data, and healthy individuals can reach higher levels of PAP.1, 2
In hemodynamic terms, PH related to increased PVR of 3.0 Wood units (WU)
Clinical classification of pulmonary hypertension
The clinical classification system for PH continues to evolve as our understanding of the pathologic basis of the various diseases that underlie the syndrome improves. The classification of PH has undergone a series of changes since it was first proposed in 1973.14
The initial classification designated only 2 categories: primary pulmonary hypertension (PPH) or secondary PH, depending on the presence or absence of identifiable causes or risk factors. Twenty-five years later (1998), the second
Summary
PH can develop in association with many different diseases and risk factors, and its presence is nearly always associated with reduced survival. Medical management of PH is largely dependent on its underlying etiology, and the combination of clinical and hemodynamic classifications of PH provides a framework for the diagnostic evaluation of PH to establish a final clinical diagnosis, and to guide therapy. The classification system for PH will continue to evolve as our understanding of the
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Two-pore channels mediated receptor-operated Ca<sup>2+</sup> entry in pulmonary artery smooth muscle cells in response to hypoxia
2018, International Journal of Biochemistry and Cell BiologyCitation Excerpt :Exploring pathological changes in PA remodeling and contractility is a key for PAH (Kuhr et al., 2012; Stenmark and Rabinovitch, 2010). It is well known that chronic hypoxia contribute to pH by enhancing proliferation and contractility of PASMC as well as intracellular Ca2+ ([Ca2+]i) level (Kuhr et al., 2012; Mcglothlin, 2012; Pak et al., 2007). The biological mechanism for the correlations between hypoxia and PAH has been actively explored in both animal models and cell culture systems for several decades.
BDNF secretion by human pulmonary artery endothelial cells in response to hypoxia
2014, Journal of Molecular and Cellular CardiologyCitation Excerpt :Accordingly, enhanced vascular tone as occurs with diseases such as pulmonary hypertension represents, at least in part, an imbalance between vasoconstriction vs. vasodilation [1–4]. In this regard, factors such as hypoxia that are known to induce and exacerbate pulmonary hypertension [5–7] can target pulmonary artery endothelial cells (PAECs) and therefore exacerbate their dysfunction. However, the mechanisms by which hypoxia affects PAECs are still under investigation.
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