[Pulmonary Hypertension: Diagnostics, Classification and Therapy]

Area of Science:

• Cardiology
• Pulmonology
• Internal Medicine

Background:

• Pulmonary hypertension (PH) is a chronic, incurable disease with a poor prognosis, characterized by elevated mean pulmonary arterial pressure (>25 mmHg).
• The primary therapeutic goal is to stabilize patients experiencing right heart failure and disease progression.

Purpose of the Study:

• To outline the diagnostic classification and therapeutic strategies for pulmonary hypertension.
• To emphasize the importance of specialized centers for PH management.
• To discuss current treatment options, including medication and risk stratification.

Main Methods:

• Diagnosis involves invasive hemodynamic measurements via right heart catheterization to classify PH (pre-capillary, post-capillary, combined).
• Risk stratification guides therapy, focusing on estimated 1-year survival rather than single target values.
• Management strategies differentiate between various PH groups, including those associated with left heart or lung disease, and idiopathic pulmonary arterial hypertension (PAH).

Main Results:

• Hemodynamic assessment is crucial for classifying PH and guiding treatment.
• Early introduction of combination therapy is recommended.
• Therapy is tailored to risk stratification and the specific type of pulmonary hypertension.

Conclusions:

• Pulmonary hypertension management requires a specialized, risk-stratified approach.
• Optimal care for associated conditions (left heart/lung disease) is paramount.
• Specific PH types, like chronic thromboembolic pulmonary hypertension, may benefit from surgical evaluation or targeted therapies such as Riociguat.