Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehac237. https://doi.org/10.1093/eurheartj/ehac237 Dr. Stephan Rosenkranz et al
Points
- The main aim of the guidelines is to provide the best management techniques to the health professional to facilitate them in making decisions related to the health of their patients. These guidelines are not an alternative to patient-practitioner relationships. Health professionals should make the best suitable decision according to circumstances with proper consultation of patients and their caregivers.
- Guidelines are prepared so physicians can easily access the latest recommendations by the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). ESC and ERS decline the responsibility of non-medical readers because they can misinterpret technical language.
- The purpose of developing ESC/ERS guidelines is to create implementation programs and educational tools for these recommendations through pocket guideline versions, lay summary, summary slides, and electronic versions via apps so everyone can have access to these guidelines and the full version is available on ERS and ESC websites, and hosted on the ERJ and EHJ websites.
- They also encourage all to adopt, endorse, implement and translate these guidelines into their own languages so every physician can benefit from them and utilize them in their medical practices.
Summary
Following are the key points from the European Society of Cardiology (ESC) and European Respiratory Society (ERS) guidelines that they present for the diagnosis and treatment of pulmonary hypertension disease:
- Mean pulmonary arterial pressure >20mmHG was used to define pulmonary hypertension (PH), pulmonary arterial hypertension (PAH) infers PVR >2WU, and pulmonary arterial wedge pressure ≤15mmHg.
- Three steps simplify the diagnostic procedure for PH: start with the preliminary examination by the first-line practitioner, then detection through echocardiography, and finally, validation by right heart catheterization in PH centers.
- Screening techniques for patients with pulmonary arterial hypertension with Systemic sclerosis and those at risk of heritable pulmonary arterial hypertension are suggested on the basis of the results of cohort studies. These implementations will help in the early detection of symptoms for diagnosing pulmonary arterial hypertension.
- Echocardiographic signs of chronic thromboembolic pulmonary hypertension (CTEPH) and improved recognition of computed tomography, along with a systematic follow-up of acute pulmonary embolism patients, will help to remediate the underdiagnoses of CTEPH.
- The assessment of PAH has been refined by adding echocardiographic and magnetic resonance imaging criteria to the table of ESC/ERS for evaluation.
- Four-stratum risk stratification is proposed at follow-up, in which large, intermediate-risk groups were divided into intermediate-low risk and intermediate-high risk groups.
- The treatment procedure for PAH is refined with the main focus on cardio-pulmonary comorbidities, risk management, and treatment goals. Early combination therapy and treatment acceleration are added as current standards at follow-up.
- They also tried narrowing the gap between adult and pediatric PAH care through different follow-up and therapeutic techniques.
- The recommendations related to sex-related problems, including pregnancy, are updated in PAH patients.
- The recommendations related to exercise programs and rehabilitation are updated for PH patients.
- PH medical therapy for group 3PH is being recommended on the basis of a randomized controlled trial positive in interstitial lung disease patients.
- The concept of chronic thrombo-embolic pulmonary disease with or without PH is also presented, opening new research doors.
- The therapeutic procedure for CTEPH is also modified, which includes multimodal therapy with surgery, PH drugs, and pulmonary balloon angioplasty.
Link to the article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac237/6673929
References Humbert, M., Kovacs, G., Hoeper, M. M., Badagliacca, R., Berger, R. M. F., Brida, M., Carlsen, J., Coats, A. J. S., Escribano-Subias, P., Ferrari, P., Ferreira, D. S., Ghofrani, H. A., Giannakoulas, G., Kiely, D. G., Mayer, E., Meszaros, G., Nagavci, B., Olsson, K. M., Pepke-Zaba, J., … Abdullaev, T. (2022). 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European Heart Journal, ehac237. https://doi.org/10.1093/eurheartj/ehac237
