Analysis of the 2022 European Society of Cardiology/European Respiratory Society Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension

PULMONARY HYPERTENSION (PH) is a significantly challenging pathophysiology in the perioperative period, as it often results in both end-stage heart and lung disease. Although the precise prevalence of PH in the population presenting for major noncardiac surgery is unknown, its impact is significant in terms of increased perioperative adverse cardiovascular events and mortality. 1 Smilowitz NR Armanious A Bangalore S et al. Cardiovascular outcomes of patients with pulmonary hypertension undergoing noncardiac surgery. Am J Cardiol. 2019; 123: 1532-1537 Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar A suspected patient with PH often presents with decreased functional capacity, which is a subjective clinical symptom consistent with objective worsening of symptoms and predictive of poor perioperative outcomes. 2 Shah AC Ma K Faraoni D et al. Self-reported functional status predicts post-operative outcomes in non-cardiac surgery patients with pulmonary hypertension. PLoS One. 2018; 13e0201914 Crossref Scopus (11) Google Scholar A thorough evaluation of a patient with PH includes the deployment of a high-risk multidisciplinary team, the benefits of which have been discussed in previous studies of similar high-risk disease processes, 3 Martin AK Shah SZ Guru PK et al. Multidisciplinary approach for lung transplantation due to COVID-19. Mayo Clin Proc Innov Qual Outcomes. 2022; 6: 200-208 Abstract Full Text Full Text PDF PubMed Google Scholar as well as the latest European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines. 4 Diaz-Gomez JL Ripoll JG Mira-Avendano I et al. Multidisciplinary perioperative management of pulmonary arterial hypertension in patients undergoing noncardiac surgery. South Med J. 2018; 111: 64-73 Crossref PubMed Scopus (10) Google Scholar ,5 Humbert M Kovacs G Hoeper MM et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022; 43: 3618-3731 Crossref PubMed Scopus (722) Google Scholar In this review, the authors outline the major recommendations from the new ESC/ERS guidelines, highlight the changes from the prior guidelines, and provide a brief overview of the literature that supports the recommendations.