Experts at the World Symposium on Pulmonary Hypertension debated the definition of pulmonary hypertension.
During the first meeting of the World Symposium on Pulmonary Hypertension (WSPH) in 1973, experts agreed on a mean pulmonary artery pressure (mPAP) greater than 25 mm Hg as the hemodynamic threshold for diagnosing PH. Nonetheless, attendees regarded this as an arbitrarily defined cutoff and acknowledged the need for additional research to elucidate the parameters of normal pulmonary circulation, according to a review published in Current Opinion in Pulmonary Medicine.
After much debate among experts, refinement of the overall definition and classification of PH and pulmonary arterial hypertension (PAH), and accumulation of substantial evidence in this area over the past several decades, the 6th WSPH Task Force on Hemodynamic Definitions and Clinical Classification recently proposed reducing the diagnostic mPAP threshold from 25 mm Hg or above to more than 20 mm Hg for all PH groups.
“This proposed change was based on evidence demonstrating that the upper limit of normal for mPAP in healthy adults is 20.6 mm Hg as well as a strong association of mildly elevated mPAPs (21-24 mm Hg) with increased mortality across diverse [PH] populations,” the review authors wrote. Read more here.
Pulmonary hypertension News: Predicting PH in newborns
When done during pregnancy, an echocardiogram — a noninvasive measurement of heart function that uses sound waves — may help doctors predict pulmonary hypertension in newborns, a study in China suggests.
An echocardiogram can show how well the heart’s right ventricle, one of its bottom pumping chambers, will push blood through to the lungs without becoming too stressed. According to researchers, prenatal echocardiogram results strongly predicted the likelihood of a baby being diagnosed with persistent pulmonary hypertension of the newborn (PPHN) after birth. Read more here.
Study: Pulmonary hypertension associated with bronchopulmonary dysplasia
For a study, researchers sought to compare the cost-utility of catheterization-required therapy in preterm babies with pulmonary hypertension to the empiric beginning of sildenafil based only on echocardiographic data.
A Markov state transition model was built to simulate the clinical scenario of a preterm infant with echocardiographic evidence of pulmonary hypertension associated with bronchopulmonary dysplasia (BPD) but no congenital heart disease who is considering starting pulmonary vasodilator therapy via one of two modeled treatment strategies—empiric or catheterization-obligate. From the literature, transitional probabilities, costs, and utilities were extracted. The indicator for plan efficacy was predicted quality-adjusted life-years. Each variable was subjected to sensitivity testing. The findings were tested for durability using a 1,000-patient Monte Carlo microsimulation.
When compared to the empiric treatment technique, the catheterization-obligate strategy cost $10,778 more and resulted in 0.02 fewer quality-adjusted life-years. Across all scenarios considered using one-way sensitivity analysis and Monte Carlo microsimulation, empiric therapy remained the more cost-effective paradigm (cost-effective in 98% of cases). Read more here.