Objectives: In the 2022 European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines, the hemodynamic definition of pulmonary hypertension (PH) was revised to mean pulmonary arterial pressure (mPAP)>20 mmHg (1 mmHg=0.133 kPa) at rest. This study aimed to evaluate the impact of the revised hemodynamic definition on the diagnosis of PH. Methods: Patients with dyspnea or highly suspected PH who underwent right heart catheterization (RHC) in Beijing Anzhen hospital affiliated to Capital Medical University from September 2021 to October 2022 were enrolled retrospectively. According to resting hemodynamics, the patients were divided into 3 groups: no-PH (mPAP≤20 mmHg) group, low-pressure PH (20 mmHg<mPAP<25 mmHg) group and high-pressure PH (mPAP≥25 mmHg) group. The diagnosis and classification of PH and the hemodynamic parameters in different groups were compared before and after the revision of diagnostic criteria. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficacy of maximum of mPAP (mPAPmax) and mPAP/cardiac output (CO) slope of multi-point in PH. Results: A total of 117 patients were included for analysis, the age was (53.7±17.5) years, 37 (31.6%) patients were male. According to the 2022 ESC/ERS definition, 99 patients were diagnosed as PH, including 8 patients (6.8%) in the low-pressure PH group and 91 patients (77.8%) in the high-pressure PH group. There were 18 patients (15.4%) in the non-PH group. Comparing to the 2015 ESC/ERS definition, 8 patients were newly diagnosed as PH. Echocardiography indexes pulmonary systolic pressure (sPAP) [(57.6±7.3) vs (38.5±13.6) mmHg], max tricuspid regurgitation velocity (TRVmax) [(360.4±28.9) vs (271.4±52.2) cm/s] and RHC index mPAP [(22.2±1.3) vs (16.1±2.6) mmHg] in low-pressure PH group were higher than those in no-PH group (all P<0.05). However, further analysis of hemodynamics during exercise showed mPAPmax [(42.1±5.6) vs (35.6±4.7) mmHg, P=0.006] and mPAP/CO slope of multi-point [(4.9±1.3) vs (3.6±1.1) mmHg·L-1·min-1,P=0.024] in low-pressure PH group were higher than those in no-PH group. The ROC curve cut-off value of mPAPmax for the diagnosis of PH was 39 mmHg, with a sensitivity of 75.0%, a specificity of 76.5%, and the area under the curve (AUC) and 95%CI is 0.816 (0.638-0.994). The ROC curve cut-off value of mPAP/CO slope of multi-point for the diagnosis of PH was 4.44 mmHg·L-1·min-1,with a sensitivity of 75.0%, a specificity of 76.5%, and an AUC (95%CI) of 0.794 (0.606-0.983). Conclusion: After the revision of the hemodynamic definition of PH in the 2022 ESC/ERS guidelines, more PH patients with pulmonary vascular disease are detected, thereby facilitating early diagnosis and treatment.
目的： 评估2022年欧洲心脏学会/欧洲呼吸学会（ESC/ERS）肺动脉高压（PH）指南将PH血流动力学诊断标准修订为平均肺动脉压（mPAP）>20 mmHg（1 mmHg=0.133 kPa）对PH诊断的影响。 方法： 回顾性收集2021年9月至2022年10月首都医科大学附属北京安贞医院住院的呼吸困难或高度怀疑PH并完成右心导管检查（RHC）的患者，按静息状态下mPAP将患者分为非PH组（mPAP≤20 mmHg）、PH低压组（20 mmHg<mPAP<25 mmHg）和PH高压组（mPAP≥25 mmHg），比较诊断标准修订前后PH诊断与分类变化及不同分组患者血流动力学指标差异，采用受试者工作特征（ROC）曲线评价最大运动负荷mPAP（mPAPmax）及多点拟合mPAP/心输出量（CO）诊断PH的效能。 结果： 117例患者年龄（53.7±17.5）岁，男性37例（31.6%）。根据2022 ESC/ERS指南标准，99例患者被诊断为PH，包括PH低压组8例（6.8%）、PH高压组91例（77.8%），非PH组18例（15.4%）。相较2015 ESC/ERS指南标准有8例新诊断PH患者。PH低压组超声心动检查肺动脉收缩压（sPAP）［（57.6±7.3）比（38.5±13.6）mmHg］、三尖瓣反流峰值流速（TRVmax）［（360.4±28.9）比（271.4±52.2）cm/s］及静息状态RHC指标mPAP［（22.2±1.3）比（16.1±2.6）mmHg］均高于非PH组（均P<0.05）。PH低压组mPAPmax［（42.1±5.6）比（35.6±4.7）mmHg，P=0.006］、多点mPAP/CO拟合直线斜率［（4.9±1.3）比（3.6±1.1）mmHg·L-1·min-1，P=0.024］均高于非PH组。mPAPmax诊断PH的ROC曲线最佳截断值为39 mmHg，灵敏度为75.0%，特异度为76.5%，曲线下面积（AUC）及95%CI为0.816（0.638~0.994）；多点拟合mPAP/CO直线斜率诊断PH的ROC曲线最佳截断值为4.44 mmHg·L-1·min-1，灵敏度为75.0%，特异度为76.5%，AUC（95%CI）为0.794（0.606~0.983）。 结论： 2022 ESC/ERS指南修订PH血流动力学诊断标准后，可更敏感地检出以肺血管病为主的PH，有助于PH早诊、早治。.