Impact of the new hemodynamic classification in the diagnosis of pulmonary hypertensionReport from a pneumology based PH center

The hemodynamic criteria for pulmonary hyperension (PH) has been recently changed according to the recommendation of the 6th world conference of PH 2018. The impact of the new haemodynamic criteria on PAH diagnosis in e.g. systemic sclerosis has been shown to be minimal (1). In the newly established Pulmonary Hypertension service at the Lung Center Munich-Gauting, 369 patients (118 female, mean age 69 (10) years) have undergone evaluation for suspected PH inculding right heart catheter. In 273 patients (77 female, mean age 70 (10) years) a manifest PH (mPAP >25 mmHg) was diagnosed. According to the new hemodynamic criteria (mPAP > 20 mmHg), the number of patients with manifest PH increased by 52 to 325 patients ( 19% increase), among them 231 patients with precapillary PH, 59 patients with postcapillary PH and 35 patients with combined pre-/postcapillary PH. In respect to the underlying diseases, the major increase was seen in PH due to left heart disease (Claas II PH, 32% increase) and PH in lung disease (class III PH, 19% increase) and in CTEPH (class IV, 13% increase), while PAH remained nearly stable. In our cohort, the new haemodynamic classification led to an increase of PH diagnosis of about 19%, mostly in PH due to left heart disease and PH due to lung disease. 1 Jaafar S, et al Eur Respir J. 2019;54(2):1900586.