TY - JOUR T1 - Mast cells: bridging the gap between pre- and post-capillary pulmonary hypertension? JF - European Respiratory Journal JO - Eur Respir J SP - 1303 LP - 1305 DO - 10.1183/09031936.00033611 VL - 37 IS - 6 AU - D. Montani AU - I.M. Lang Y1 - 2011/06/01 UR - http://erj.ersjournals.com/content/37/6/1303.abstract N2 - According to the current guidelines for the diagnosis and treatment of pulmonary hypertension (PH) [1, 2], the Dana Point diagnostic classification separates pre-capillary PH, i.e. PH due to pulmonary vascular disease mainly affecting the pre-capillary arteriolar compartment (i.e. Dana Point groups 1, 3, 4 and 5), from post-capillary disease that originates distal to the capillaries and involves morphological changes in the pre-capillary compartment only occur after a significant pressure increase in the venous compartment (i.e. Dana Point group 2). Currently, a single haemodynamic parameter, i.e. wedge pressure [3], that is commonly flawed by methodological errors [4] is employed to distinguish between pre- and post-capillary disease. This distinction is vital because treatment is completely different for the two classes of disease [2], with a virtual “therapeutic gap” between the two disorders. For example, epoprostenol, the life-saving treatment for pulmonary arterial hypertension (PAH) [5], was shown to be detrimental in congestive heart failure [6].PH with left-sided heart disease is classified as a non-PAH form that includes all conditions associated with increased left ventricular filling pressure. A transpulmonary gradient (mean pulmonary arterial pressure (Ppa)−pulmonary capillary wedge pressure (Ppcw)) >12 mmHg has been arbitrarily declared as the haemodynamic threshold indicating significant pre-capillary pulmonary vascular disease in left-sided heart disease, and has been classified as “reactive” or “out-of-proportion” PH. By contrast, transpulmonary gradients ≤12 mmHg have been classified as passive PH, i.e. PH due to hydrostatic pressure transmitted across the capillary bed of the lung, implying a lack of significant anatomical changes of the pre-capillary vessels. Naturally, these pressures can be directly changed by relieving left-sided pressures, for example by diuretic … ER -