Journal article
WHO's in second?: A practical review of World Health Organization group 2 pulmonary hypertension
Chest, Vol.144(2), pp.638-650
08/2013
DOI: 10.1378/chest.12-2114
PMCID: PMC3734892
PMID: 23918108
Abstract
World Health Organization (WHO) group 2 pulmonary hypertension (PH) due to left-side heart disease (ie, heart failure or left-sided valvular heart disease) is the most common form of PH in western countries. Distinguishing patients with WHO group 2 PH, particularly the subset of patients with PH due to heart failure with preserved ejection fraction (HFpEF), from those with WHO group 1 pulmonary arterial hypertension (PAH) is challenging. Separating the two conditions is of vital importance because treatment strategies differ completely. Furthermore, therapies that are indicated for WHO group 1 PAH may be harmful in patients with WHO group 2 PH. We review the somewhat confusing PH nomenclature and the WHO classification system and rationale behind it. We then focus on left-side heart disorders that cause PH. An aging population and advances in the medical management of common cardiovascular disorders have caused the prevalence of heart failure to rise significantly, with more than one-half of patients having HFpEF. We review contemporary studies that focus on clinical and echocardiographic findings that help to distinguish HFpEF from PAH in the patient with PH. We discuss the typical, and sometimes atypical, hemodynamic profiles that characterize these two groups, review challenges in the interpretation of data obtained by right-sided heart catheterization, and highlight special maneuvers that may be required for accurate diagnosis. Finally, we review the largely disappointing studies on the use of PAH-specific therapies in patients with WHO group 2 PH, including the use of prostacyclins, endothelin receptor antagonists, and the more promising phosphodiesterase-5 inhibitors.
Details
- Title: Subtitle
- WHO's in second?: A practical review of World Health Organization group 2 pulmonary hypertension
- Creators
- Sif Hansdottir - University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: sif-hansdottir@uiowa.eduDayna J Groskreutz - University of Iowa Carver College of Medicine, Iowa City, IABrian K Gehlbach - University of Iowa Carver College of Medicine, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Chest, Vol.144(2), pp.638-650
- Publisher
- United States
- DOI
- 10.1378/chest.12-2114
- PMID
- 23918108
- PMCID
- PMC3734892
- ISSN
- 0012-3692
- eISSN
- 1931-3543
- Grant note
- K23HL088020 / NHLBI NIH HHS K08HL089392 / NHLBI NIH HHS K08 HL089392 / NHLBI NIH HHS K23 HL088020 / NHLBI NIH HHS
- Language
- English
- Date published
- 08/2013
- Academic Unit
- Neurology; Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984020751802771
Metrics
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