The main advances in classification, diagnosis, risk stratification and follow-up and treatment will be presented this morning by members of the Guideline Task Force at a congress Symposium. The
Guidelines represent a joint effort of the ESC and the European Respiratory Society, with endorsement by the International Society for Heart and Lung Transplantation and the Association for European Paediatric Cardiology.
Pulmonary hypertension is a haemodynamic and pathophysiological state found in multiple clinical conditions. These have been classified in the new
Guidelines into six clinical groups with specific characteristics. This classification was developed at the 4th World Symposium on Pulmonary Hypertension in California, in February 2008, of which a summary was recently published in JACC.
The definition central to the
Guidelines is that of pulmonary arterial hypertension (PAH) reserved for a condition in which the mean pulmonary arterial pressure measured invasively is >25 mmHg. In addition, pulmonary wedge pressure by definition has to be <15 mmHg with a normal or reduced cardiac output. Importantly, the Guidelines stress that the presence and extent of pulmonary hypertension can only be measured invasively. Echocardiography can only provide an estimate on whether pulmonary hypertension is present or not.
To highlight the remarkable differences between the six clinical groups, a comparative description of pathology, pathobiology, genetics, epidemiology and risk factors is presented. Moreover, the
Guidelines contain practical information related to clinical presentation, diagnostic features and treatment.
Practical management of patients with suspected PAH will be facilitated by a new diagnostic algorithm featured in the Guidelines. In order to make the diagnosis of PAH, all other groups of pulmonary hypertension must be excluded.
As most therapeutic advances occurred in the area of PAH, its treatment is described in more detail. Based on the publication of recent randomised controlled trials, a new treatment algorithm is provided with updated levels of evidence in grade of recommendation.
Moreover, the
Guidelines contain the current approval status of medications in different geographic areas. This is important for implementation in regions outside Europe. With respect to patient management, the
Guidelines contain recommendations for the evaluation of severity of the patients’ condition, treatment goals and reasonable intervals for follow-up.
ESC/ERS pulmonary hypertension
Guidelines, Tuesday 1 September 11:00-12:30, Rome - Zone 3, FPN 3626-3629