Table 2.

Current Hemodynamic Definitions of Pulmonary Hypertension and PH-HFpEF

Hemodynamic Definition of Pulmonary Hypertension 3
Definitions	Hemodynamic Criteria	WHO Groups
Pre-capillary PH	mPAP >20mmHg PAWP ≤ 15mmHg PVR ≥3 WU	1,3,4,5
Isolated post-capillary PH	mPAP >20mmHg PAWP > 15mmHg PVR <3 WU	2,5
Combined pre- and post-capillary PH	mPAP >20mmHg PAWP > 15mmHg PVR ≥3 WU	2,5
Components of PH-HFpEF Definition in Clinical Trials and Epidemiologic studies
Modality	Methods or Criteria Used
Clinical	Elevated BNP or NT-pro-BNP Heart Failure Signs and Symptoms (Framingham Criteria) Heart Failure Hospitalization
Echocardiography	LVEF ≥ 40–55% and RVSP > 35–40mmHg or TRV > 2.9 m/s
Hemodynamic	mPAP≥ 25mmHg TPG ≥ 12mmHg PAWP ≥ 15–20mmHg or LVEDP >15 Confrontational Fluid Challenge 500mL of Normal Saline over 5–10minutes; PAWP>15mmHg 6, 7 Normal Saline at 7mL/kg over 5–10minutes; PAWP≥18mmHg8 Normal Saline at 100–200mL/min over two 7minute intervals; PAWP/saline slope ≥25 (±12) mmHg*L*min9 Normal Saline 10mL/kg; ≥21(±4)mmHg10 Exercise Upright cycle ergometer with continuous incremental ramp cycle (5–30W/min) at 60rpm; mPAP/CO >2–3mmHg/L/min 11, 12 Supine cycle ergometry at 60rpm increasing workload 10–30W every 3–5minutes; mPAP>30mmHg13 Weighted (4lb) Arm Adduction or Supine cycle ergometry 20W workload x 5 minutes then increasing 10W every 3 minutes; PAWP ≥ 25mmHg 10, 14

WHO: World Health Organizations; PH: pulmonary hypertension; mPAP: mean pulmonary artery pressure; PAWP: pulmonary artery wedge pressure; PVR: pulmonary vascular resistance; LVEF: left ventricular ejection fraction; RVSP: right ventricular systolic pressure; TRV: tricuspid regurgitant velocity; TPG: transpulmonary gradient; W:Watts