Acute pulmonary vasoreactivity : a simple test revisited in the contemporary era - a narrative review
Grignola, Juan C. (Universidad de la República (Uruguai))
Trujillo, Pedro (Universidad de la República (Uruguai))
Sandoval, Julio (ABC Hospital)
Domingo Ribas, Enric (Universitat Autònoma de Barcelona. Departament de Biologia Cel·lular, de Fisiologia i d'Immunologia)

Date:	2026
Abstract:	The acute vasodilator challenge during right heart catheterization (RHC) provides a deeper understanding of the pulmonary circulation by assessing vasoreactivity. The current criteria for a positive acute vasoreactivity test (AVT) are simplified to steady-state metrics, based on cutoff points derived from expert opinion. A positive AVT identifies a specific, but very rare, PH phenotype that may respond long-term to calcium-channel blockers. Growing evidence supports updating the role and criteria of AVT in pulmonary arterial hypertension, broadening its use to other PH groups, and potentially offering new insights for predicting risk and/or treatment outcomes. This study aims to revisit the uses, criteria, and goals of AVT in patients with PH beyond group 1 and to propose a new approach for phenotyping the pulmonary vascular response to the acute vasodilator challenge during diagnostic RHC. We propose a continuous multi-parameter criterion to evaluate the entire right ventricular afterload during AVT, such as the pulmonary vascular resistance-pulmonary arterial capacitance curve and alpha distensibility coefficient. AVT could assess the residual vasoreactive reserve of the pulmonary circulation as a provocative test for predicting risk outcomes and/or treatment responses.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Pulmonary vasoreactivity ; Pulmonary hypertension ; Acute vasoreactivity testing ; Pulmonary vascular resistance-pulmonary ; Arterial capacitance relationship
Published in:	International journal of cardiology. Heart & vasculature, Vol. 62 (December 2025) , art. 101847, ISSN 2352-9067

DOI: 10.1016/j.ijcha.2025.101847
PMID: 41438393

11 p, 3.6 MB

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