Hämodynamische Definition der pulmonalen Hypertonie: Kommentar zu der vorgeschlagenen Änderung durch das 6^th World Symposium on Pulmonary Hypertension

 

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Zusammenfassung

Die Ende 2015 veröffentlichten ESC/ERS-Leitlinien und andere internationale Empfehlungen definierten die pulmonale Hypertonie (PH) bisher durch einen invasiv gemessenen mittleren pulmonal arteriellen Druck (mPAP) ≥ 25 mmHg in Ruhe. Auf dem 6^th World Symposium on Pulmonary Hypertension in Nizza wurde eine Modifikation dieser hämodynamischen Definition im Sinne einer Senkung des Schwellenwertes auf > 20 mmHg vorgeschlagen. Für die präkapilläre PH wird zusätzlich ein pulmonaler Gefäßwiderstand (PVR) ≥ 3 Wood-Einheiten (WE) gefordert. Diese Änderung muss im Hinblick auf die zugrunde liegende Rationale und mögliche Konsequenzen kritisch hinterfragt werden; es bedarf daher einer eingehenden Erläuterung. Insbesondere muss klargestellt werden, dass diese Änderung aktuell keinen Einfluss auf die evidenzbasierte und zulassungskonforme Verschreibung von Medikamenten zur gezielten Therapie der pulmonal arteriellen Hypertonie (PAH) hat.

Abstract

The ESC/ERS guidelines (published at the end of 2015) and other international recommendations defined pulmonary hypertension (PH) by an invasively measured mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg at rest. At the 6^th World Symposium on Pulmonary Hypertension in Nice a modification of this hemodynamic definition in the sense of lowering the threshold to > 20 mmHg was proposed. A pulmonary vascular resistance (PVR) ≥ 3 Wood units (WU) is additionally required for the diagnosis of pre-capillary PH. This modification must be critically reviewed with regard to the underlying rationale and possible consequences. Therefore, a detailed explanation is required. In particular, it must be made clear that this change currently has no influence on the evidence-based and approval-compliant prescription of drugs for the targeted therapy of pulmonary arterial hypertension (PAH).

Die Autoren sind Mitglieder der Arbeitsgruppe 25 „Pulmonale Hypertonie“ der (§) Deutschen Gesellschaft für Kardiologie, Herz- und Kreislaufforschung (DGK), der Sektion „Kardiorespiratorische Interaktion“ der (‡) Deutschen Gesellschaft für Pneumologie (DGP) oder der (#) Deutschen Gesellschaft für Pädiatrische Kardiologie (DGPK) und fungieren als Leiter der Task Forces der „Kölner Konsensus Konferenz pulmonale Hypertonie“;

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