Thread by @DrJaredDyer

1/#MRPearls Pulmonary hypertension (PH) is a wide ranging disease that is associated with ⬆️ morbidity and mortality. How comfortable are you with right heart catherizations and the changing diagnostic criteria in PH? #tweetorial @AvrahamCooperMD

2/#MRPearls Right heart catherizations in the supine position remain the gold standard for the diagnosis of PH. This is typically done using a fluid-filled balloon-tipped thermodilution catheter. Check out this image to see the various wave forms within each heart chamber.

3/#MRPearls This video does a fantastic job of demonstrating the pressure waveform changes that are seen in each chamber. @MichaeLheureux @AndreaMytinger @michellebr00ks @VCU_IMRes @GoodishIntent @JJRyanMD

4/#MRPearls The accepted PH definition that had been used from 1973-2018 required a mean pulmonary artery pressure (mPAP) >25 mmHg. However, there is emerging evidence to suggest that we need to rethink this definition. @KevinSwiatek @mkashiouris @samirashojaee @PSinkam @tciden

5/#MRPearls A study completed by Kovacs et al. in the @EuroRespSoc challenged our initial thinking on the upper limit of normal mPAP. They suggested that in healthy populations the PAP rarely exceeded 20 mmHg. ncbi.nlm.nih.gov/pubmed/1932495…

6/#MRPearls There have been several large registry studies showing increasing morbidity and mortality for mPAP >19. Check out this study from @JAMACardio regarding prognostic effects on borderline PH. @LauraLee714 @Xian_Qiao

ncbi.nlm.nih.gov/pubmed/2907133…

7/#MRPearls So given this information, should we adjust our PH definition in order to identify patients earlier and possibly modify progression? @aoglasser @tony_breu @LizSonntag @AKaiserMD @CCM_improv_doc @Niall_PCCM @DrSpencerHarris

8/#MRPearls It has been proposed by the 6th World Symposium on Pulmonary Hypertension to alter the hemodynamic definition for PH. Note, the use of pulmonary vascular resistance would increase diagnostic specificity.

9/#MRPearls Possible benefits of using the revised definition for PH:
1⃣ Earlier diagnosis of PH to help ⬇️ morbidity
2⃣ Use of PVR will ⬆️ specificity for pre-capillary PH
3⃣ Help better focus treatment modalities

10/#MRPearls What are some possible draw backs of using the revised definition?
1⃣ Increased diagnostics (time, costs, etc.)
2⃣ Potential limited clinical benefit
3⃣ Potential psychological harm regarding diagnosis

11/#MRPearls Given this information, which PH definition will you be using in your clinical practice? @critcarekid @ERitterMD @bqueenhoo @alan_dow @AdamRodmanMD @AdamGarberMD @pduncan54 @DrDaniGenMed @GenMedDoc @NateWarnerMD @B_M_Wiese @khess567

12/#MRPearls Check out the POINT/COUNTERPOINT in the April 2020 issue of @accpchest for a great discussion between Drs. Frantz and Maron regarding utilization of the revised PH definition.

13/#MRPearls Don't forget about World Pulmonary Hypertension Day on May 5, 2020. @worldphday @PHAssociation @marinanaz @bqueenhoo @ptfaddenMD @cderekleiner @AjayPMD @CoryRTrankle @jaideeppatelmd @kriskrao @JeremyTurling @abouzaki_md @pranav_mankad