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Pulmonale Hypertonie

Definition und diagnostische Klassifikation

Pulmonary hypertension

Definition and diagnostic classification

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Die erste klinische Klassifikation und hämodynamische Definition der pulmonalen Hypertonie (PH) wurde 1973 in Genf beschlossen. Die diagnostische Klassifikation in eine primäre und sekundäre pulmonale Hypertonie wurde dann in Evian 1998 geändert, indem 5 Gruppen eingeführt und die Gruppe 1 mit dem Begriff der pulmonal-arteriellen Hypertonie (PAH) besetzt wurde. Diese Einteilung wurde bei den folgenden Kongressen in Venedig 2003 und Dana Point 2008 mit einigen Adaptationen beibehalten.

Die erste hämodynamische Definition von 1973 sprach von einer PH, wenn der mittlere pulmonale Druck (PAP) 25 mmHg in Ruhe oder 30 mmHg bei Belastung überschreitet. In Dana Point wurde diese Definition in Frage gestellt. Die Analyse der hämodynamischen Daten von gesunden Probanden führte zu der Schlussfolgerung, dass der PAP 14,0±3,3 mmHg beträgt und unabhängig vom Geschlecht und nur minimal von Alter und Körperposition abhängig ist. Dagegen ist der PAP unter Belastung stark vom Alter und vom Belastungsgrad abhängig. Daher wird der normale PAP in den aktuellen Leitlinien mit 8–20 mmHg angegeben und eine PH wird durch einen PAP ≥25 mmHg definiert. Der Belastungsteil der Definition wurde aufgegeben.

Abstract

The first clinical classification and hemodynamic definition of pulmonary hypertension (PH) was introduced at a WHO meeting in Geneva in 1973. The diagnostic classification was updated at the world conference in Evian, 1998, introducing 5 clinical groups instead of the original groups of primary and secondary PH. Although changes have been made, the basic structure of this classification was adopted in the following world congresses in Venice 2003 and Dana Point 2008.

Since 1973, PH was hemodynamically defined as mean pulmonary arterial pressure (PAP) >25 mmHg at rest or >30 mmHg during exercise. In 2008, the hemodynamic definition was discussed again. The analysis of the published data, based on invasive measurements in healthy individuals, suggested that resting PAP is 14.0±3.3 mmHg and independent of gender and is only mildly influenced by posture and age. During exercise, however, PAP is dependent on exercise level and age. Accordingly, the Dana Point statement defines the normal range of resting mean PAP between 8 and 20 mmHg and PH as resting mean PAP ≥25 mmHg. The exercise part of the old definition of PH was abandoned.

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  1. Klinische Abteilung für Pulmonologie, Universitätsklinik für Innere Medizin (UKIM), Medizinische Universität Graz, Auenbruggerplatz 20, 8036, Graz, Österreich

    G. Kovacs, N. Tröster, S. Scheidl & H. Olschewski

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  1. G. Kovacs
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  2. N. Tröster
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  3. S. Scheidl
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  4. H. Olschewski
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Correspondence to G. Kovacs.

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Kovacs, G., Tröster, N., Scheidl, S. et al. Pulmonale Hypertonie. Pneumologe 7, 165–173 (2010). https://doi.org/10.1007/s10405-009-0377-2

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