Pulmonary Hypertension: Expert Didactics and Discussion (Master Class)-Interpret the Hemodynamics: Distinguish for Precapillary and Postcapillary Pulmonary

Video Transcription

Video Summary

Dr. Allwing, a cardiologist specializing in pulmonary hypertension (PH), discusses the complexities of distinguishing pre-capillary from post-capillary PH, emphasizing the challenges in diagnosis and treatment. Updates from recent European guidelines and their U.S. critiques highlight that invasive hemodynamics remains essential despite limitations and potential misclassifications. Key hemodynamic measures such as pulmonary artery pressure, pulmonary vascular resistance (PVR), and wedge pressure thresholds have evolved but remain debated, underscoring the need to interpret catheterization data within clinical context.<br /><br />Phenotyping patients—evaluating echocardiography, clinical history, and comorbidities—is crucial, as many patients do not fit neatly into standard PH groups. Echo signs like left atrial size, E/E’ ratio, and RV function aid differentiation but are not definitive. Exercise testing, including invasive cardiopulmonary exercise testing, can unmask hidden left heart dysfunction or pulmonary vascular disease.<br /><br />Treatment is especially nuanced in post-capillary or combined pre- and post-capillary PH, where PAH-specific therapies often lack efficacy or may cause harm. Current guidelines discourage use of PAH drugs in isolated post-capillary PH. Careful patient assessment, expert referral, and ongoing reassessment are essential, highlighting the need for personalized diagnostic and therapeutic approaches in this heterogenous disease spectrum.

Keywords

pulmonary hypertension

PH

pre-capillary PH

post-capillary PH

hemodynamics

pulmonary vascular resistance

echocardiography

cardiopulmonary exercise testing

PAH-specific therapies

personalized treatment