Diagnostic criteria for pulmonary hypertension

Pulmonary hypertension is a relatively serious symptom, which mainly refers to the rapid increase in pulmonary artery pressure that exceeds normal standards. Patients with severe pulmonary hypertension may also suffer from right heart failure, which is very harmful to their health. Pulmonary hypertension attacks occur very frequently, so timely treatment is required. So, what are the diagnostic criteria for pulmonary hypertension?

Pulmonary hypertension refers to a hemodynamic and pathophysiological state in which the pulmonary artery pressure rises above a certain threshold, which can lead to right heart failure. It can be an independent disease, a complication, or a syndrome. The hemodynamic diagnostic criteria are: at rest at sea level, the mean pulmonary artery pressure detected by right cardiac catheterization is ≥25 mmHg. Pulmonary hypertension is a common and frequently occurring disease with high disability and mortality rates, and should be taken seriously.

1. Laboratory examination

Autoantibodies, liver function and hepatitis virus markers, HIV antibodies, thyroid function tests, blood gas analysis, prothrombin time and activity, BNP or NT-proBNP.

2. Electrocardiogram

Prompts right ventricular overload, hypertrophy and right atrial dilatation.

3. Chest X-ray

Signs suggesting pulmonary hypertension include: transverse diameter of the right lower pulmonary artery ≥15mm, pulmonary artery segment protrusion ≥3mm, dilation of the central pulmonary artery and loss of peripheral pulmonary vessels forming a "residual root sign", enlargement of the right atrium and right ventricle, and increase in the cardiothoracic ratio.

4. Echocardiography

It is used to estimate pulmonary artery pressure and exclude other causes, such as congenital heart disease and valvular disease. It can also evaluate right heart function and determine prognosis.

5. Pulmonary function test

Used to identify airway and lung parenchymal lesions, with special reference to the carbon monoxide diffusion capacity.

6. Lung ventilation/perfusion scan

Helps determine whether there is pulmonary embolism.

7. High-resolution CT and enhanced CT

Provide more detailed imaging information of lung parenchyma and pulmonary vascular.

8. Magnetic resonance imaging

It can directly evaluate the morphology, size and function of the right ventricle, and can also non-invasively evaluate some right heart hemodynamic characteristics.

9. Polysomnography

Used to rule out hypoxic pulmonary hypertension.

10. Cardiopulmonary exercise test

It can evaluate cardiac function and gas exchange capacity, and maximum oxygen consumption and EqCO2 can be used to predict prognosis.

11.6 minutes walking distance

An important method for evaluating patients' exercise tolerance.

12. Right cardiac catheterization and acute vasodilation test

Right cardiac catheterization is the gold standard for diagnosing pulmonary hypertension and can accurately obtain the hemodynamic characteristics of the pulmonary circulation and right cardiac system. Acute vasodilator testing is used to determine whether patients respond to calcium blocker therapy.

13. Pulmonary angiography

Rule out pulmonary embolism, pulmonary artery tumor, etc.

14. Thoracoscopic lung biopsy

It is not recommended for routine use.