Pulmonary Hypertension Medical Slides

Present the updated 6th WSPH (2022) definitions: PH is now mPAP >20 mmHg (previously ≥25 mmHg), pre-capillary PH adds PVR >2 WU (previously >3 WU), post-capillary PH requires PAWP >15 mmHg. Combined pre- and post-capillary PH: PAWP >15 mmHg AND PVR >2 WU. Emphasize the clinical significance — patients with mPAP 21-24 mmHg have increased mortality in multiple registries, justifying earlier identification.

Present the combination therapy evidence: AMBITION trial (2015) — upfront ambrisentan + tadalafil reduced clinical failure by 50% versus monotherapy, establishing initial combination as standard of care. GRIPHON (selexipag reduced morbidity/mortality by 40%), SERAPHIN (macitentan reduced morbidity/mortality by 45%), and REPLACE trial (switching PDE5i to riociguat in inadequate responders). Current strategy: upfront double combination (ERA + PDE5i) with escalation to triple therapy including prostacyclin pathway.

Present the ESC/ERS risk stratification using WHO functional class, 6-minute walk distance (>440 m low risk), BNP/NT-proBNP levels, right atrial area and pericardial effusion on echo, hemodynamics (CI, RAP, SvO2). Low risk: maintain therapy. Intermediate risk: consider escalation. High risk: escalate to parenteral prostacyclin, refer for transplant evaluation. Reference the COMPERA and French registry data validating this framework.