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[ESC guidelines 2015 on pulmonary hypertension].

H Olschewski1,2, G Kovacs3,4,

  • 1Universitätsklinik für Innere Medizin, Klinische Abteilung für Lungenkrankheiten, Medizinische Universität Graz, Auenbruggerplatz 20, 8036, Graz, Österreich. horst.olschewski@medunigraz.at.

Herz
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PubMed
Summary

The 2015 European Society of Cardiology (ESC) and European Respiratory Society (ERS) guidelines update pulmonary hypertension (PH) diagnosis and treatment. New recommendations include targeted drugs for chronic thromboembolic PH and upfront combination therapy for pulmonary arterial hypertension (PAH).

Keywords:
Combination drug therapyDiagnosisEchocardiographyGuidelinePulmonary hypertension

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Area of Science:

  • Cardiology
  • Respiratory Medicine
  • Pulmonology

Context:

  • The European Society of Cardiology (ESC) and European Respiratory Society (ERS) released updated guidelines in 2015 for pulmonary hypertension (PH).
  • These guidelines provide critical recommendations for diagnosing and treating PH, maintaining the established five-group classification with minor internal shifts.
  • Pulmonary arterial hypertension (PAH) is distinguished from other PH classifications, including those related to left heart disease, lung disease, chronic thromboembolism, and multifactorial mechanisms.

Purpose:

  • To outline the updated diagnostic criteria and therapeutic strategies for pulmonary hypertension (PH) based on the 2015 ESC/ERS guidelines.
  • To detail the classification of PH, emphasizing the criteria for pulmonary arterial hypertension (PAH) diagnosis.
  • To highlight advancements in PH treatment, including newly approved drugs and therapeutic approaches.

Summary:

  • Pulmonary hypertension (PH) is diagnosed via right heart catheterization, with a mean pulmonary arterial pressure ≥25 mmHg at rest. PAH diagnosis requires a pulmonary capillary wedge pressure ≤15 mmHg and pulmonary vascular resistance >3 Wood units.
  • Echocardiography is the primary non-invasive diagnostic tool for PH, particularly in patients with collagen vascular disease, necessitating annual follow-up.
  • The guidelines incorporate novel drugs approved since the previous recommendations and introduce a targeted therapy for inoperable chronic thromboembolic PH, alongside a focus on upfront combination therapy for PAH.

Impact:

  • The updated guidelines provide a standardized framework for clinicians in diagnosing and managing various forms of pulmonary hypertension.
  • Incorporation of new pharmacotherapies and treatment strategies aims to improve patient outcomes in pulmonary arterial hypertension and chronic thromboembolic PH.
  • The emphasis on echocardiography and specific diagnostic criteria enhances the accuracy and efficiency of PH assessment.