{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:53:32Z","timestamp":1792032812742,"version":"4.4.0"},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pneumologie"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>In der Neufassung der ESC\/ERS-Leitlinien 2022 zur pulmonalen Hypertonie (PH) kam es zu wesentlichen \u00c4nderungen in der h\u00e4modynamischen Definition sowie zu einer weiteren Verfeinerung in der Klassifikation des Lungenhochdrucks.<\/jats:p><jats:p>Als bedeutende Neuerung gilt die Einf\u00fchrung eines neuen Grenzwerts des mittleren pulmonalarteriellen Druckes (mPAP) f\u00fcr die Definition der PH. Eine PH wird nun durch eine Erh\u00f6hung des mPAP &gt;\u200a20\u200ammHg, ermittelt durch Rechtsherzkatheter, definiert. Des Weiteren wurde der Grenzwert des pulmonalen Gef\u00e4\u00dfwiderstands (PVR) zur Definition einer pr\u00e4kapill\u00e4ren PH verringert. Eine pr\u00e4kapill\u00e4re PH liegt nun bereits ab einem PVR &gt;\u200a2\u200aWU und einem pulmonalarteriellen Verschlussdruck (PAWP) \u2264\u200a15\u200ammHg vor. Die zunehmende Evidenz f\u00fcr die klinische Relevanz der pulmonalen Belastungsh\u00e4modynamik f\u00fchrte schlie\u00dflich auch zur Wiederaufnahme des Belastungs-PH-Terminus in die Leitlinien. Die Belastungs-PH wird als Verh\u00e4ltnis zum Herzzeitvolumen (CO) \u00fcber einen pathologischen mPAP\/CO-Slope &gt;\u200a3\u200ammHg\/L\/min definiert. In der Klassifikation werden weiterhin f\u00fcnf Gruppen unterschieden: die pulmonalarterielle Hypertonie (Gruppe 1), PH assoziiert mit Linksherzerkrankungen (Gruppe 2), PH assoziiert mit Lungenerkrankungen und\/oder Hypoxie (Gruppe 3), PH assoziiert mit pulmonalarterieller Obstruktion (Gruppe 4) und PH mit unklaren und\/oder multifaktoriellen Mechanismen (Gruppe 5).<\/jats:p><jats:p>In der folgenden Leitlinien\u00fcbersetzung soll auf die Neuerungen eingegangen, deren Hintergr\u00fcnde n\u00e4her beleuchtet und m\u00f6gliche Schwierigkeiten in ihrer klinischen Anwendung diskutiert werden.<\/jats:p>","DOI":"10.1055\/a-2145-4648","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T23:32:45Z","timestamp":1700004765000},"page":"854-861","source":"Crossref","is-referenced-by-count":5,"title":["Die neue Definition und Klassifikation der pulmonalen Hypertonie"],"prefix":"10.1055","volume":"77","author":[{"given":"Philipp","family":"Douschan","sequence":"first","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria"},{"name":"Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Egenlauf","sequence":"first","affiliation":[{"name":"Zentrum f\u00fcr Pulmonale Hypertonie, Thoraxklinik am Universit\u00e4tsklinikum Heidelberg, Heidelberg, Germany"},{"name":"Abteilung f\u00fcr Pneumologie und Beatmungsmedizin, Thoraxklinik am Universit\u00e4tsklinikum Heidelberg, Heidelberg, Germany"},{"name":"Translational Lung Research Center Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ulrich","sequence":"first","affiliation":[{"name":"Klinik f\u00fcr Pneumologie, Universit\u00e4tsspital Z\u00fcrich, Z\u00fcrich, Schweiz"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabor","family":"Kovacs","sequence":"first","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Gall","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ekkehard","family":"Gr\u00fcnig","sequence":"additional","affiliation":[{"name":"Zentrum f\u00fcr Pulmonale Hypertonie, Thoraxklinik am Universit\u00e4tsklinikum Heidelberg, Heidelberg, Germany"},{"name":"Translational Lung Research Center Heidelberg (TLRC), Member of the German Centre for Lung Research (DZL), Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Hager","sequence":"additional","affiliation":[{"name":"Department for Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum M\u00fcnchen, Technical University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Heberling","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Carl Gustav Carus an der TU Dresden, Med. Klinik I, Bereich Pneumologie, Dresden, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Koehler","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsklinikum Freiburg, Department Innere Medizin, Klinik f\u00fcr Pneumologie, Freiburg, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horst","family":"Olschewski","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Internal Medicine, Medical University of Graz and Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-J\u00fcrgen","family":"Seyfarth","sequence":"additional","affiliation":[{"name":"Department of Pneumology, Medical Clinic II, University Hospital of Leipzig, Leipzig, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athiththan","family":"Yogeswaran","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,11,14]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1240","DOI":"10.1161\/CIRCULATIONAHA.115.020207","article-title":"Association of Borderline Pulmonary Hypertension With Mortality and Hospitalization in a Large Patient Cohort: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program","volume":"133","author":"B A Maron","year":"2016","journal-title":"Circulation"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1183\/09031936.00145608","article-title":"Pulmonary arterial pressure during rest and exercise in healthy subjects: a systematic review","volume":"34","author":"G Kovacs","year":"2009","journal-title":"Eur Respir J"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1183\/09031936.00008611","article-title":"Pulmonary vascular resistances during exercise in normal subjects: a systematic review","volume":"39","author":"G Kovacs","year":"2012","journal-title":"Eur Respir J"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.jchf.2016.10.012","article-title":"The Influence of Age on Hemodynamic Parameters During Rest and\u00a0Exercise in\u00a0Healthy Individuals","volume":"5","author":"E Wolsk","year":"2017","journal-title":"JACC Heart Fail"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1164\/rccm.201706-1215OC","article-title":"Mild Elevation of Pulmonary Arterial Pressure as a Predictor of Mortality","volume":"197","author":"P Douschan","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"e009729","DOI":"10.1161\/JAHA.118.009729","article-title":"Mild Pulmonary Hypertension Is Associated With Increased Mortality: A Systematic Review and Meta-Analysis","volume":"7","author":"D Kolte","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1801914","DOI":"10.1183\/13993003.01914-2018","article-title":"Pulmonary hypertension in chronic lung disease and hypoxia","volume":"53","author":"S D Nathan","year":"2019","journal-title":"Eur Respir J"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1002\/art.37838","article-title":"Borderline mean pulmonary artery pressure in patients with systemic sclerosis: transpulmonary gradient predicts risk of developing pulmonary hypertension","volume":"65","author":"C J Valerio","year":"2013","journal-title":"Arthritis Rheum"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/S2213-2600(15)00543-3","article-title":"A global view of pulmonary hypertension","volume":"4","author":"M M Hoeper","year":"2016","journal-title":"Lancet Respir Med"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S2213-2600(20)30317-9","article-title":"Pulmonary vascular resistance and clinical outcomes in patients with pulmonary hypertension: a retrospective cohort study","volume":"8","author":"B A Maron","year":"2020","journal-title":"Lancet Respir Med"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1136\/annrheumdis-2019-216476","article-title":"Haemodynamic phenotypes and survival in patients with systemic sclerosis: the impact of the new definition of pulmonary arterial hypertension","volume":"79","author":"P Xanthouli","year":"2020","journal-title":"Ann Rheum Dis"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"e023839","DOI":"10.1161\/JAHA.121.023839","article-title":"Influence of Upright Versus Supine Position on Resting and Exercise Hemodynamics in Patients Assessed for Pulmonary Hypertension","volume":"11","author":"C Berlier","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"776956","DOI":"10.3389\/fmed.2021.776956","article-title":"Comparison of Repetitive Cardiac Output Measurements at Rest and End-Exercise by Direct Fick Using Pulse Oximetry vs. Blood Gases in Patients With Pulmonary Hypertension","volume":"8","author":"M Duknic","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"2539","DOI":"10.1093\/eurheartj\/ehm037","article-title":"How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology","volume":"28","author":"W J Paulus","year":"2007","journal-title":"Eur Heart J"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"3297","DOI":"10.1093\/eurheartj\/ehz641","article-title":"How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)","volume":"40","author":"B Pieske","year":"2019","journal-title":"Eur Heart J"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"2103181","DOI":"10.1183\/13993003.03181-2021","article-title":"Diagnostic, prognostic and differential-diagnostic relevance of pulmonary haemodynamic parameters during exercise: a systematic review","volume":"60","author":"K Zeder","year":"2022","journal-title":"Eur Respir J"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jacc.2019.10.048","article-title":"Exercise Pulmonary Hypertension Predicts Clinical Outcomes in Patients\u00a0With Dyspnea on Effort","volume":"75","author":"J E Ho","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1161\/CIRCHEARTFAILURE.110.959437","article-title":"Pulmonary vascular response patterns during exercise in left ventricular systolic dysfunction predict exercise capacity and outcomes","volume":"4","author":"G D Lewis","year":"2011","journal-title":"Circ Heart Fail"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.chest.2020.08.2110","article-title":"Exercise Pulmonary Resistances Predict Long-Term Survival in Systemic Sclerosis","volume":"159","author":"K Zeder","year":"2021","journal-title":"Chest"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1183\/13993003.00990-2016","article-title":"Exercise pulmonary haemodynamics predict outcome in patients with systemic sclerosis","volume":"48","author":"A Stamm","year":"2016","journal-title":"Eur Respir J"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.chest.2016.02.634","article-title":"Pressure-Flow During Exercise Catheterization Predicts Survival in\u00a0Pulmonary Hypertension","volume":"150","author":"E D Hasler","year":"2016","journal-title":"Chest"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"e004750","DOI":"10.1161\/CIRCHEARTFAILURE.117.004750","article-title":"Pulmonary Capillary Wedge Pressure Patterns During Exercise Predict Exercise Capacity and Incident Heart Failure","volume":"11","author":"A S Eisman","year":"2018","journal-title":"Circ Heart Fail"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"e016339","DOI":"10.1161\/JAHA.120.016339","article-title":"Normal and Abnormal Relationships of Pulmonary Artery to Wedge Pressure During Exercise","volume":"9","author":"R F Bentley","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1183\/09031936.00139009","article-title":"Guidelines for the diagnosis and treatment of pulmonary hypertension","volume":"34","author":"N Galie","year":"2009","journal-title":"Eur Respir J"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"1700578","DOI":"10.1183\/13993003.00578-2017","article-title":"An official European Respiratory Society statement: pulmonary haemodynamics during exercise","volume":"50","author":"G Kovacs","year":"2017","journal-title":"Eur Respir J"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1183\/13993003.01032-2015","article-title":"2015 ESC\/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT)","volume":"46","author":"N Gali\u00e8","year":"2015","journal-title":"Eur Respir J"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"1801913","DOI":"10.1183\/13993003.01913-2018","article-title":"Haemodynamic definitions and updated clinical classification of pulmonary hypertension","volume":"53","author":"G Simonneau","year":"2019","journal-title":"Eur Respir J"}],"container-title":["Pneumologie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2145-4648.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T23:33:06Z","timestamp":1700004786000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2145-4648"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":27,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,14]]},"published-print":{"date-parts":[[2023,11]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2145-4648","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0934-8387","1438-8790"],"issn-type":[{"value":"0934-8387","type":"print"},{"value":"1438-8790","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}