Pulmonary Hypertension: Advances in Clinical Diagnosis and Management

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: 30 August 2025 | Viewed by 765

Special Issue Editor


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Guest Editor
Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
Interests: pulmonary hypertension; pulmonary vascular disease; lung disease; left-heart disease

Special Issue Information

Dear Colleagues,

Pulmonary hypertension (PH) includes a range of conditions leading to elevated pressures within the pulmonary arteries, defined as a mean pulmonary artery pressure of >20 mmHg. This disease state is classified into five main groups, including pulmonary arterial hypertension, PH associated with left-sided heart disease, PH associated with lung disease, PH associated with pulmonary artery obstruction (most commonly due to chronic pulmonary embolism), and PH with less clear and/or multifactorial mechanisms. In the absence of therapy, the vascular remodeling with elevated pressures leads to failure of the right ventricle, which is the primary cause of death. Dyspnea is the most common symptom, but recognition of PH is often delayed by many months. When initial evaluation including echocardiography leads to a high suspicion of PH, this should ultimately lead to right heart catheterization for definitive diagnosis and appropriate classification and therapy. The therapeutic approach relies on careful assessment of the cause and severity of the PH. 

Groundbreaking advances have been made in the PH space over the past few decades, including the definition of PH, basic science knowledge, diagnostic approaches, risk stratification, and approaches to therapy. However, major deficiencies remain in understanding certain basic mechanisms of the disease and the ideal approaches to therapy. We will review the PH disease state, including these basic scientific aspects and the diagnostic and therapeutic approaches to different forms of PH.

Dr. Victor F. Tapson
Guest Editor

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Keywords

  • pulmonary arterial hypertension
  • pulmonary hypertension
  • pulmonary vascular disease
  • chronic thromboembolic pulmonary hypertension
  • lung disease
  • left heart disease
  • functional class
  • right heart catheterization
  • prostacyclins
  • endothelin receptor antagonists
  • phosphodiesterase inhibitor
  • soluble guanylate cyclase stimulators
  • sotatercept

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Published Papers (2 papers)

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Research

10 pages, 1633 KiB  
Article
Changes in Pulmonary Hypertension Following Transcatheter Aortic Valve Implantation: Implications for Prognosis
by Hao-Wei Lee, Chi-Hung Huang, Chih-Hui Chin, Po-Chin Chou, Chia-Hsiu Chang and Eng-Thiam Ong
J. Clin. Med. 2025, 14(10), 3463; https://doi.org/10.3390/jcm14103463 - 15 May 2025
Abstract
Background: Pulmonary hypertension (PH) is a known prognostic factor in the setting of transcatheter aortic valve implantation (TAVI), but data on post-TAVI PH changes and their clinical relevance are limited. Method: This retrospective cohort included 55 PH patients (52.7% male; mean age 81.5 [...] Read more.
Background: Pulmonary hypertension (PH) is a known prognostic factor in the setting of transcatheter aortic valve implantation (TAVI), but data on post-TAVI PH changes and their clinical relevance are limited. Method: This retrospective cohort included 55 PH patients (52.7% male; mean age 81.5 ± 8.9 years) classified by pre-TAVI systolic pulmonary artery pressure into mild (36–50 mmHg), moderate (50–60 mmHg), and severe (≥60 mmHg) PH. PH was reassessed using the closest post-TAVI echocardiogram. The primary outcome was a 2-year composite of all-cause mortality or heart failure hospitalization. Result: PH improved in 61.8% and worsened in 14.5% of patients after TAVI. Those with worsened PH had a significantly higher risk of adverse outcomes compared to those with no PH change (log-rank p = 0.029), while event rates were similar between improved and unchanged PH groups (log-rank p = 0.742). Cox regression analysis identified PH worsening as an independent predictor of adverse outcomes (HR: 8.775; 95% CI: 2.669–28.851; p < 0.001). Conclusions: PH deterioration after TAVI appears to be associated with worse outcomes, possibly more indicative than PH improvement. Full article
(This article belongs to the Special Issue Pulmonary Hypertension: Advances in Clinical Diagnosis and Management)
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13 pages, 255 KiB  
Article
The Role of the Pulmonary Artery Obstruction Index Ratio in Predicting the Clinical Course of Pulmonary Embolism
by Serap Atik, Recai Ergün, Dilek Ergün, Ecem Narin Çopur, Abidin Kılınçer and Muslu Kazım Körez
J. Clin. Med. 2025, 14(5), 1673; https://doi.org/10.3390/jcm14051673 - 1 Mar 2025
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Abstract
Background/Objective: This study aimed to investigate the relationship between the pulmonary arterial computed tomography obstruction index ratio (CTOI) and the simplified pulmonary embolism severity index (sPESI), one of the clinical probability scoring modalities, in determining the severity of PE and to determine whether [...] Read more.
Background/Objective: This study aimed to investigate the relationship between the pulmonary arterial computed tomography obstruction index ratio (CTOI) and the simplified pulmonary embolism severity index (sPESI), one of the clinical probability scoring modalities, in determining the severity of PE and to determine whether CTOI is a mortality marker. Methods: The study included 117 patients diagnosed with PE via computed tomography pulmonary angiography (CTPA). The CTOI was determined according to the localization of the embolus and the obstruction caused by the embolus in the vessel. Patients were divided into two groups, namely low-risk and high-risk groups, according to their sPESI values. Patient deaths up to six months after PE diagnosis were recorded. Results: According to the sPESI classification, although the CTOI was higher in the high-risk group compared to the low-risk group, no significant difference was found between the groups. The mortality rate was significantly higher in the high-risk group. After six months of follow-up, there was no difference in the CTOI rate between the patients who died and those who survived. Conclusions: Although CTPA is the gold standard for diagnosing PE, it would be more appropriate to use it together with clinical findings to determine the severity of the disease. Further evaluation is needed to investigate the usefulness of the obstruction index and CT findings of right ventricular dysfunction for classifying patient risk and determining therapeutic options. Full article
(This article belongs to the Special Issue Pulmonary Hypertension: Advances in Clinical Diagnosis and Management)
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