Arq Bras Cardiol: Imagem cardiovasc. 2023; 36(2): e20230041
How to Proceed in a Multimodality Analysis for the Diagnosis and Risk Stratification of Pulmonary Hypertension?
DOI: 10.36660/abcimg.20230041i
Pulmonary hypertension (PH) is a complex multiorgan system disease defined as mean pulmonary artery pressure (mPAP) > 20 mmHg. The etiologies related to pathological changes in pulmonary vasculature leading to PH are wide. Hemodynamic categorization considers precapillary PH, represented by pulmonary arterial hypertension (PAH), pulmonary vascular resistance (PVR) > 3 Woods units (WU), and pulmonary arterial wedge pressure < 15 mmHg. Postcapillary PH, represented by left heart disease, involves PVR > 3 WU and pulmonary arterial wedge pressure > 15 mmHg. Clinical categorization considers 5 groups. Incidence per group is not well known; however, group 2 (associated with left heart disease) is the most common cause of PH. PAH (group 1) is still a highly devastating condition causing limited quality of life and high mortality, mostly related to right ventricle (RV) failure. Group 3 refers to PH associated with lung diseases and or hypoxia. Group 4 corresponds to PH associated with pulmonary artery obstructions, and group 5 to PH with unclear and or multifactorial mechanisms. 1 Currently, the diagnostic algorithm for PH considers a 3-step approach, from clinical suspicion by first-line physicians considering vital signs, functional class, etc.; non-invasive RV parameters by transthoracic echocardiography (TTE), cardiac magnetic resonance imaging (CMRI), computed tomography (CT), and pulmonary vascular assessment by ventilation perfusion (V/Q) scan. For diagnostic confirmation, however, right heart catheterization is necessary, preferably in PH centers. 2 , 3
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Keywords: Diagnosis; Pulmonary Hypertension; Risk Factors
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