Hemodynamic assessment of pulmonary hypertension

Table 1 Hemodynamic definitions of pulmonary hypertension as assessed by right heart catheterization

Definition	Characteristics	Clinical group(s)1
PH	mPAP ≥ 25 mmHg	All
Pre-capillary PH	mPAP ≥ 25 mmHg	1 Pulmonary arterial hypertension
	PAOP ≤ 15 mmHg	3 PH due to lung diseases
	CO N or reduced2	4 Chronic thromboembolic PH
		5 PH with unclear and/or multi- factorial mechanisms
Post-capillary PH	mPAP ≥ 25 mmHg	2 PH due to left heart disease
	PAOP > 15 mmHg
	CO N or reduced2
Passive	TPG ≤ 12 mmHg
Reactive ("out of proportion")	TPG > 12 mmHg

¹DanaPoint classification;

²High cardiac output can be present in cases of hyperkinetic conditions such as systemic-to-pulmonary shunts (only in the pulmonary circulation), anemia, hyperthyroidism, etc. PH: Pulmonary hypertension; CO: Cardiac output; PAP: Pulmonary arterial pressure; PAOP: Pulmonary artery occlusion pressure; TPG: Transpulmonary pressure gradient (mPAP-PAOP).

Table 2 Recommendations for right heart catheterization[1]

Statement	Class of re-commendation	Level of evidence
RHC is indicated in all patients with pulmonary arterial hypertension to confirm the diagnosis, to evaluate the severity and when PAH specific drug is considered	I	C
RHC should be performed for confirmation of efficacy of pulmonary arterial hypertension specific drug therapy	IIa	C
RHC should be performed for confirmation of clinical deterioration and as baseline for the evaluation of the effect of treatment escalation and/or combination therapy	IIa	C

RHC: Right heart catheterization.