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Updated PH Haemodynamic Definition — EECC MCQ

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ModeratePulmonary Vascular DiseaseUpdated PH Haemodynamic DefinitionEECC

A 58-year-old woman presents with progressive exertional dyspnoea. Cardiac catheterisation shows mPAP 22 mmHg, PAWP 14 mmHg, PVR 2.5 WU, and a cardiac output of 5.0 L/min. Echocardiography shows a dilated RA with RV dysfunction. These haemodynamics are borderline. The 2022 ESC/ERS PH Guidelines changed the diagnostic thresholds. What are the current haemodynamic criteria?

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Correct answer: D — PH is now defined as mPAP >20 mmHg (previously >25 mmHg); pre-capillary PH additionally requires PAWP ≤15 mmHg AND PVR >2 WU — this patient meets all criteria for pre-capillary PH

The 2022 ESC/ERS PH Guidelines lowered the haemodynamic definition of PH from mPAP ≥25 mmHg (2015 guidelines) to mPAP >20 mmHg, based on evidence that mPAP 21-24 mmHg is associated with adverse outcomes and is above the upper limit of normal (20.6 mmHg in healthy individuals). Pre-capillary PH additionally requires: PAWP ≤15 mmHg AND PVR >2 WU (previously >3 WU). This patient (mPAP 22, PAWP 14, PVR 2.5 WU) meets all criteria for pre-capillary PH under the new definition. The lowered thresholds aim to enable earlier diagnosis and treatment of PAH, particularly important given evidence that earlier PAH-specific therapy improves outcomes.

Reference: ESC/ERS (2022): Guidelines for Pulmonary Hypertension