Potential Clinical Impact of Revised Pulmonary Hypertension Definitions at Moderate AltitudeTake-home Points
Background: Pulmonary hypertension (PH) and precapillary PH definitions have been revised. Before 2018, PH was defined by a mean pulmonary arterial pressure ≥ 25 mm Hg, and precapillary PH was defined by a pulmonary vascular resistance ≥ 3 Wood units and a pulmonary arterial wedge pressure ≤ 15 mm H...
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Elsevier
2025-03-01
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| Series: | CHEST Pulmonary |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S294978922400059X |
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| author | August Longino, MD, MPH Alexandra N. Fuher, MD Kaitlyn Mcleod, MD Roger S. Winters, MD William K. Cornwell, MD Lindsay M Forbes, MD Todd Bull, MD |
| author_facet | August Longino, MD, MPH Alexandra N. Fuher, MD Kaitlyn Mcleod, MD Roger S. Winters, MD William K. Cornwell, MD Lindsay M Forbes, MD Todd Bull, MD |
| author_sort | August Longino, MD, MPH |
| collection | DOAJ |
| description | Background: Pulmonary hypertension (PH) and precapillary PH definitions have been revised. Before 2018, PH was defined by a mean pulmonary arterial pressure ≥ 25 mm Hg, and precapillary PH was defined by a pulmonary vascular resistance ≥ 3 Wood units and a pulmonary arterial wedge pressure ≤ 15 mm Hg. In 2018, the mean pulmonary arterial pressure threshold dropped to 20 mm Hg. In 2022, the diagnostic threshold of pulmonary vascular resistance dropped from ≥ 3 to > 2 Wood units. The implications of the revised definitions at altitude remain unclear. Research Question: Do revised definitions capture similar patients at altitude and sea level? Study Design and Methods: We analyzed hemodynamic data from patients’ right heart catheterization procedures at 1,609 m. We extracted clinical data on PH diagnosis, progression, and mortality from the electronic medical record and the National Death Index. Results: A total of 2,382 patients were analyzed. Mean resident altitude ± SD was 1,631.1 ± 674 m. Pre-2018, 1,412 patients (59.2%) had PH and 508 patients (21.3%) had precapillary PH. Applying the post-2018 definition resulted in 307 patients (12.8%) being diagnosed with PH, including 86 (3.6%) with a diagnosis of precapillary PH. Applying the post-2022 definition resulted in 306 patients (12.8%) being diagnosed with precapillary PH (P < .05). Patients newly diagnosed with PH had age- and sex-adjusted mortality lower than patients with pre-2018 PH (hazard ratio [HR], 0.67; 95% CI, 0.54-0.83; P < .001) and higher than patients without PH (HR, 0.46; 95% CI, 0.39-0.56). Compared with patients with pre-2018 precapillary PH, patients with post-2022 precapillary PH demonstrated mortality (HR, 0.7; 95% CI, 0.53-0.91; P = .009). There was no significant difference in mortality or progression between patients with post-2018 and pre-2018 precapillary PH. Interpretation: In this study, at moderate altitude, revised definitions of PH identified patients with a greater likelihood of mortality, similar to sea level findings. The post-2022 definition of precapillary PH increased the prevalence of precapillary PH, identifying a population with lower mortality, without progressive disease. Further research on this population is needed. |
| format | Article |
| id | doaj-art-4dcba86e14ef4074a0d93626ce3bc287 |
| institution | DOAJ |
| issn | 2949-7892 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | CHEST Pulmonary |
| spelling | doaj-art-4dcba86e14ef4074a0d93626ce3bc2872025-08-20T03:13:51ZengElsevierCHEST Pulmonary2949-78922025-03-013110009310.1016/j.chpulm.2024.100093Potential Clinical Impact of Revised Pulmonary Hypertension Definitions at Moderate AltitudeTake-home PointsAugust Longino, MD, MPH0Alexandra N. Fuher, MD1Kaitlyn Mcleod, MD2Roger S. Winters, MD3William K. Cornwell, MD4Lindsay M Forbes, MD5Todd Bull, MD6Department of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; CORRESPONDENCE TO: August Longino, MD, MPHDepartment of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CODepartment of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CODepartment of Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CODepartment of Medicine, Cardiology and Clinical Translational Research Center, University of Colorado Anschutz Medical Campus, Aurora, CODivision of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, CODivision of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Aurora, COBackground: Pulmonary hypertension (PH) and precapillary PH definitions have been revised. Before 2018, PH was defined by a mean pulmonary arterial pressure ≥ 25 mm Hg, and precapillary PH was defined by a pulmonary vascular resistance ≥ 3 Wood units and a pulmonary arterial wedge pressure ≤ 15 mm Hg. In 2018, the mean pulmonary arterial pressure threshold dropped to 20 mm Hg. In 2022, the diagnostic threshold of pulmonary vascular resistance dropped from ≥ 3 to > 2 Wood units. The implications of the revised definitions at altitude remain unclear. Research Question: Do revised definitions capture similar patients at altitude and sea level? Study Design and Methods: We analyzed hemodynamic data from patients’ right heart catheterization procedures at 1,609 m. We extracted clinical data on PH diagnosis, progression, and mortality from the electronic medical record and the National Death Index. Results: A total of 2,382 patients were analyzed. Mean resident altitude ± SD was 1,631.1 ± 674 m. Pre-2018, 1,412 patients (59.2%) had PH and 508 patients (21.3%) had precapillary PH. Applying the post-2018 definition resulted in 307 patients (12.8%) being diagnosed with PH, including 86 (3.6%) with a diagnosis of precapillary PH. Applying the post-2022 definition resulted in 306 patients (12.8%) being diagnosed with precapillary PH (P < .05). Patients newly diagnosed with PH had age- and sex-adjusted mortality lower than patients with pre-2018 PH (hazard ratio [HR], 0.67; 95% CI, 0.54-0.83; P < .001) and higher than patients without PH (HR, 0.46; 95% CI, 0.39-0.56). Compared with patients with pre-2018 precapillary PH, patients with post-2022 precapillary PH demonstrated mortality (HR, 0.7; 95% CI, 0.53-0.91; P = .009). There was no significant difference in mortality or progression between patients with post-2018 and pre-2018 precapillary PH. Interpretation: In this study, at moderate altitude, revised definitions of PH identified patients with a greater likelihood of mortality, similar to sea level findings. The post-2022 definition of precapillary PH increased the prevalence of precapillary PH, identifying a population with lower mortality, without progressive disease. Further research on this population is needed.http://www.sciencedirect.com/science/article/pii/S294978922400059Xaltitudehypoxic vasoconstrictionpulmonary hypertensionright ventricular failure |
| spellingShingle | August Longino, MD, MPH Alexandra N. Fuher, MD Kaitlyn Mcleod, MD Roger S. Winters, MD William K. Cornwell, MD Lindsay M Forbes, MD Todd Bull, MD Potential Clinical Impact of Revised Pulmonary Hypertension Definitions at Moderate AltitudeTake-home Points CHEST Pulmonary altitude hypoxic vasoconstriction pulmonary hypertension right ventricular failure |
| title | Potential Clinical Impact of Revised Pulmonary Hypertension Definitions at Moderate AltitudeTake-home Points |
| title_full | Potential Clinical Impact of Revised Pulmonary Hypertension Definitions at Moderate AltitudeTake-home Points |
| title_fullStr | Potential Clinical Impact of Revised Pulmonary Hypertension Definitions at Moderate AltitudeTake-home Points |
| title_full_unstemmed | Potential Clinical Impact of Revised Pulmonary Hypertension Definitions at Moderate AltitudeTake-home Points |
| title_short | Potential Clinical Impact of Revised Pulmonary Hypertension Definitions at Moderate AltitudeTake-home Points |
| title_sort | potential clinical impact of revised pulmonary hypertension definitions at moderate altitudetake home points |
| topic | altitude hypoxic vasoconstriction pulmonary hypertension right ventricular failure |
| url | http://www.sciencedirect.com/science/article/pii/S294978922400059X |
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