phenomenon · claim-type · cross-domain-transfer · mechanism · claim-relation · replication-status · limitation — grounded in the full text| phenomenon | a disease whose presence is decided entirely by numbers from a catheter, where the numbers have no natural boundary and the boundary chosen changes who is ill— “Whatever the mPAP cut-off value considered for defining PH (≥25 or >20 mmHg), it is important to emphasise that this value used in isolation cannot characterise a clinical condition and does not define the pathological process per se .” | |
| claim-type | method— “The general purpose of clinical classification of PH is to categorise clinical conditions associated with PH based on similar pathophysiological mechanisms, clinical presentation, haemodynamic characteristics and therapeutic management.” | |
| method — evidence | — “Considering this mPAP of 14 mmHg, two standard deviations would suggest mPAP >20 mmHg as above the upper limit of normal ( i.e. above the 97.5th percentile). This definition is, therefore, no longer arbitrary, but based on a scientific approach.” | |
| object of study — evidence | — “Since the 1st World Symposium on Pulmonary Hypertension (WSPH) in 1973, pulmonary hypertension (PH) has been arbitrarily defined as mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest, measured by right heart catheterisation. Recent data from normal subjects has shown that normal mPAP was 14.0±3.3 mmHg. Two standard deviations above this… | |
| research question — evidence | — “Whatever the mPAP cut-off value considered for defining PH (≥25 or >20 mmHg), it is important to emphasise that this value used in isolation cannot characterise a clinical condition and does not define the pathological process per se .” | |
| contribution — evidence | — “A mPAP of 20 mmHg should be considered as the upper limit of normal value. This new definition has been recently proposed by others [ 20 – 22 ]. However, this abnormal elevation of mPAP in isolation is not sufficient to define PVD as it can be due to an increase in CO or PAWP. Pre-capillary PH is best defined by the concomitant presence of… | |
| mechanism | THE OLD NUMBER WAS ARBITRARY AND THE 1973 MEETING SAID SO: `it was recognised that this upper limit of normal mPAP of 25 mmHg was somewhat empirical and arbitrarily defined. However, this conservative cut-off value allowed physicians to discriminate severe PH due to primary PH from other forms of PH ... characterised by a lower mPAP.` The threshold was chosen to separate the severe cases from everything else, not to mark where normal ends - a working boundary that became the definition of a disease for 45 years— “In the report of the meeting, it was recognised that this upper limit of normal mPAP of 25 mmHg was somewhat empirical and arbitrarily defined [ 2 ]. However, this conservative cut-off value allowed physicians to discriminate severe PH due to primary PH from other forms of PH (mainly due to lung diseases) characterised by a lower mPAP.” | mechanisms[0] |
| mechanism | AND IT WAS KEPT FOR ITS CONSEQUENCES, NOT ITS ACCURACY: `This definition REMAINED UNCHANGED during the subsequent WSPH meetings FROM 1998 TO 2013, at least in part to preclude potential overdiagnosis and overtreatment of PH.` Four international meetings declined to move a number they knew was arbitrary, because of what moving it would do. A definition held in place by its downstream effects is the cleanest instance of this in the corpus— “This definition remained unchanged during the subsequent WSPH meetings from 1998 to 2013 [ 4 – 6 ], at least in part to preclude potential overdiagnosis and overtreatment of PH.” | mechanisms[1] |
| mechanism | AND THE NEW NUMBER WAS ALREADY IN THE 1961 REPORT: `In 1961, a report of the World Health Organization (WHO) Expert Committee on Chronic Cor Pulmonale mentioned clearly that the mean pulmonary arterial pressure does not normally exceed 15 mmHg ... and that the value was little affected by age AND NEVER EXCEEDED 20 mmHg.` The 2018 threshold is 20 mmHg. The evidence for the new boundary is 57 years older than the boundary it replaces, and the paper cites it as its first reference— “In 1961, a report of the World Health Organization (WHO) Expert Committee on Chronic Cor Pulmonale mentioned clearly that the mean pulmonary arterial pressure (mPAP) does not normally exceed 15 mmHg when the subject is at rest in a lying position, and that the value was little affected by age and never exceeded 20 mmHg [ 1 ].” | mechanisms[2] |
| mechanism | AND THE NEW ONE IS A PERCENTILE: from `1187 normal subjects from 47 studies`, `mPAP at rest was 14.0+/-3.3 mmHg`, so `two standard deviations would suggest mPAP >20 mmHg as above the upper limit of normal ( i.e. above the 97.5th percentile). This definition is, therefore, no longer arbitrary, but based on a scientific approach.` The replacement for an arbitrary cut is a distributional convention - mean plus two standard deviations is a choice about how much of a normal population to call abnormal, and 2.5% is as much a convention as 25 mmHg was— “Considering this mPAP of 14 mmHg, two standard deviations would suggest mPAP >20 mmHg as above the upper limit of normal ( i.e. above the 97.5th percentile). This definition is, therefore, no longer arbitrary, but based on a scientific approach.” | mechanisms[3] |
| mechanism | AND THE COMPANION CRITERION IS ADMITTED TO BE ARBITRARY, FOUR PARAGRAPHS LATER: `This cut-off value of PVR >=3 WU is also quite arbitrary since some recent data suggest that PVR >2 WU could be also considered abnormal. In this sense, the use of a cut-off value of PVR >=3 WU IS CONSERVATIVE.` One definition, two thresholds: one de-arbitrarised by a percentile and one defended as arbitrary and conservative, and the same document says both— “This cut-off value of PVR ≥3 WU is also quite arbitrary since some recent data suggest that PVR >2 WU could be also considered abnormal [ 6 ]. In this sense, the use of a cut-off value of PVR ≥3 WU is conservative, suggesting the presence of a manifest pre-capillary PH.” | mechanisms[4] |
| mechanism | AND A NUMBER ALONE IS DECLARED INSUFFICIENT TO NAME A DISEASE: `Whatever the mPAP cut-off value considered for defining PH (>=25 or >20 mmHg), it is important to emphasise that this value used in isolation cannot characterise A clinical condition and does not define the pathological process per se.` The pressure can be raised by cardiac output, by a shunt, by wedge pressure or by blood viscosity - so the definition needs a second measurement to say WHERE the resistance is— “Whatever the mPAP cut-off value considered for defining PH (≥25 or >20 mmHg), it is important to emphasise that this value used in isolation cannot characterise a clinical condition and does not define the pathological process per se .” | mechanisms[5] |
| mechanism | AND THE PATIENTS ADDED BY THE CHANGE HAVE NO EVIDENCE BASE: `a change in the haemodynamic definition of PH due to PVDs does not imply treating these additional patients, but highlights the importance of close monitoring in this population. Prospective trials are required to determine whether this PH population might benefit from specific management.` A diagnosis is extended to people for whom no treatment is indicated and none has been tested - stated plainly, in the section that makes the change— “Nevertheless, a change in the haemodynamic definition of PH due to PVDs does not imply treating these additional patients, but highlights the importance of close monitoring in this population. Prospective trials are required to determine whether this PH population might benefit from specific management.” | mechanisms[6] |
| mechanism | AND THE EVIDENCE FOR MOVING IT IS THAT THE EXCLUDED BAND ALREADY BEHAVES LIKE THE DISEASE: of 38 systemic sclerosis patients with mPAP 21-24 mmHg re-catheterised, `16 of these (42%) developed overt PH`, and `Patients with so-called BORDERLINE mPAP at diagnosis were more likely to develop overt PAH than patients with mPAP <=20 mmHg (HR 3.7)`. In a 547-patient Austrian cohort, `both borderline PH and manifest PH were significantly associated with poor survival` (HR 2.37 and 5.05). The band between the old threshold and the new one was never healthy; it was outside the definition— “mPAP 21–24 mmHg was documented in 86 patients at baseline; of these, 38 underwent a second RHC during the follow-up (median follow-up 48±35 months) and 16 of these (42%) developed overt PH (mPAP ≥25 mmHg). The mean mPAP and PVR at baseline of these 16 patients was 22±2 mmHg and 2.9±0.6 WU, respectively; at follow-up, mean mPAP and PVR… | mechanisms[7] |
| mechanism | AND A DEFINITION REMOVED IN 2008 WAS NOT RESTORED, FOR A MEASUREMENT REASON: `In 2004, PH was defined as resting mPAP >25 mmHg or exercise mPAP >30 mmHg. At the 4th WSPH in 2008, however, the `EXERCISE` part of the definition was removed.` Revisited in 2018 and refused again - `too many uncertainties persist to allow the reintroduction of a clinically useful definition of exercise PH` - because `it was impossible to distinguish LHD from PVD patients with confidence` and the measurement is `impractical as a clinical routine`. A criterion refused on the grounds that it cannot be measured, not that it is untrue | mechanisms[8] |
| mechanism | AND ONE WHOLE CLASS IS DEFINED BY WHAT IS NOT KNOWN ABOUT ITS MEMBERS: `the concept supporting the classification of a clinical condition ... into group 5 is, again, the lack of robust data allowing a definite recognition of predominant pathophysiological mechanisms, or describing the histopathological findings or yet, describing management strategies.` Group 5 was `disorders directly affecting the pulmonary vasculature` in 1998 and `MISCELLANEOUS` in 2003. Membership is an epistemic state, not a property of the disease - a paper leaves group 5 when the literature improves, not when the patient changes Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | mechanisms[9] |
| mechanism | AND TWO MEMBERS WERE DEMOTED FROM CONDITIONS TO RISK FACTORS: splenectomy, because `no other particular phenotype or change in clinical behaviour has been associated with [it], suggesting that it should be better considered as A risk factor for PH instead of A PARTICULAR CONDITION deserving a specific classification`; and thyroid disorders, `IT WAS A CONSENSUS TO WITHDRAW [them] from the classification as A SPECIFIC ENTITY and better discuss their role as risk factors`. The test for being a class rather than a correlate is whether membership predicts anything else Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | mechanisms[10] |
| mechanism | AND THE BAR FOR MOVING ANYTHING ELSE IS STATED: `We propose that changes be made only after the generation of robust data to support such reclassification.` A classification that names its own amendment rule - compare the same task force moving two entries out on exactly that ground in the paragraphs above Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | mechanisms[11] |
| extends | the 1st WSPH definition of 1973 (mPAP >=25 mmHg) and its restatements at every WSPH from 1998 to 2013, which this task force replaces Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | claim_relations[0] |
| extends | Kovacs et al.'s pooled analysis of 1187 normal subjects from 47 right-heart-catheterisation studies, from which the new threshold is derived Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | claim_relations[1] |
| critiques | the use of a single pressure value as a diagnosis - 'this value used in isolation cannot characterise a clinical condition and does not define the pathological process per se' Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | claim_relations[2] |
| critiques | the 2004 exercise criterion ('exercise mPAP >30 mmHg'), removed in 2008 and refused readmission here because exercise PAWP cannot distinguish left heart disease from pulmonary vascular disease Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | claim_relations[3] |
| sense | `pulmonary hypertension`, 1973-2018 sense - `mPAP >=25 mmHg at rest, measured by right heart catheterisation`, a value the defining meeting called `somewhat empirical and arbitrarily defined` Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | senses[0] |
| sense | `pre-capillary PH`, 2018 sense - THREE conditions at once: `mPAP >20 mmHg, PAWP <=15 mmHg and PVR >=3 WU`. The second and third exist to say that the raised pressure is resistance and not flow or wedge Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | senses[1] |
| sense | `borderline PH` - mPAP 21-24 mmHg: the band between the old threshold and the new one, which had a name while it was outside the definition Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | senses[2] |
| sense | `exercise PH` - part of the definition in 2004 (`exercise mPAP >30 mmHg`), removed in 2008, reconsidered and refused in 2018 because exercise PAWP cannot be measured reliably enough to tell left heart disease from pulmonary vascular disease Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | senses[3] |
| sense | `group 5` - PH `with unclear and/or multifactorial mechanisms`; previously `disorders directly affecting the pulmonary vasculature` (1998) and `MISCELLANEOUS` (2003). The class of conditions we do not yet understand Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | senses[4] |
| sense | `definite` vs `possible` drug association - definite means `data based on outbreaks, epidemiological case-control studies or large multicentre series`; possible means `multiple case series`. A membership grade defined by STUDY DESIGN Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | senses[5] |
| control | requiring PAWP <=15 mmHg and PVR >=3 WU alongside the pressure, so that a raised mPAP counts only when it is resistance — held Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. — rules out calling high cardiac output, a left-to-right shunt, left heart disease or hyperviscosity 'pulmonary vascular disease' Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | controls[0] |
| control | refusing to reintroduce exercise PH into the definition — held Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. — rules out a criterion that separates the healthy from the ill but cannot say which disease, and that is 'impractical as a clinical routine' Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | controls[1] |
| control | stating that the new definition 'does not imply treating these additional patients' — partial Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. — rules out reading a widened diagnostic boundary as a widened treatment indication Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | controls[2] |
| control | requiring robust data before any further reclassification, and applying that rule immediately by demoting splenectomy and thyroid disorders out of group 5 — held Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. — rules out a classification that grows by plausibility Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | controls[3] |
| weight | the 1st WSPH definition of 1973 (mPAP >=25 mmHg) and its restatements at every WSPH from 1998 to 2013, which this task force replaces — 0.95 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | claim_relations[0] |
| weight | Kovacs et al.'s pooled analysis of 1187 normal subjects from 47 right-heart-catheterisation studies, from which the new threshold is derived — 0.95 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | claim_relations[1] |
| weight | the use of a single pressure value as a diagnosis - 'this value used in isolation cannot characterise a clinical condition and does not define the pathological process per se' — 0.9 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | claim_relations[2] |
| weight | the 2004 exercise criterion ('exercise mPAP >30 mmHg'), removed in 2008 and refused readmission here because exercise PAWP cannot distinguish left heart disease from pulmonary vascular disease — 0.85 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | claim_relations[3] |
| audit | pulmonary hypertension (PH) —operationalised-as→ mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest — Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but the span says PH was ARBITRARILY defined this way and that the definition is now revised to >20 mmHg; superseded. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[0] |
| note | pulmonary hypertension (PH) —operationalised-as→ mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest — '(PH) HAS BEEN…' The adverb is the authors' own, in the first sentence of the abstract - and the 1973 report is quoted later saying the same thing about itself Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[0] |
| relation | pulmonary hypertension (PH) —operationalised-as→ mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest — from 1973 to this paper, having the disease meant having a catheter reading at or above 25 mmHg at rest - a number the defining meeting recorded as arbitrary Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[0] |
| weight | pulmonary hypertension (PH) —operationalised-as→ mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest — 0.95 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[0] |
| note | Pre-capillary PH —operationalised-as→ mPAP >20 mmHg, PAWP ≤15 mmHg and PVR ≥3 WU — 'Pre-capillary PH is best…' Lowering one threshold forced two more into the definition - because 'THIS VALUE USED…', and the further down the pressure scale you go the more true that is Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[1] |
| relation | Pre-capillary PH —operationalised-as→ mPAP >20 mmHg, PAWP ≤15 mmHg and PVR ≥3 WU — the 2018 definition is a conjunction of three catheter measurements, two of them present only to prove that the raised pressure is resistance rather than flow Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[1] |
| weight | Pre-capillary PH —operationalised-as→ mPAP >20 mmHg, PAWP ≤15 mmHg and PVR ≥3 WU — 0.95 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[1] |
| note | increase in cardiac output —causes→ PAP elevation — 'PAP ELEVATION…' The edge runs from the cause to the reading, against the order of the sentence. This is the argument that forced PVR into the definition: a measurement with many causes cannot, alone, be a diagnosis Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[2] |
| relation | increase in cardiac output —causes→ PAP elevation — raised pulmonary pressure has several unrelated causes - high cardiac output, a shunt, raised wedge pressure, hyperviscosity - only one of which is vascular disease Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[2] |
| weight | increase in cardiac output —causes→ PAP elevation — 0.9 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[2] |
| note | forms of PH with unclear and/or multifactorial mechanisms —part-of→ group 5 — `Since the basis of our classification system was established in 1998, group 5 has passed through significant changes. Initially describing `disorders directly affecting the pulmonary vasculature`, then named `MISCELLANEOUS` during the 3rd WSPH in 2003, and finally reaching its current presentation, this group includes forms of PH with unclear and/or multifactorial mechanisms.` The renaming across three meetings has no edge type in schema 0.3 - `renamed-across-fields` is false here, because it is one field renaming its own category over time. Filed in the open questions rather than forced into the nearest type Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[5] |
| relation | forms of PH with unclear and/or multifactorial mechanisms —part-of→ group 5 — group 5 contains the conditions for which no predominant mechanism has been established - membership is a statement about the literature, not the patient Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[5] |
| weight | forms of PH with unclear and/or multifactorial mechanisms —part-of→ group 5 — 0.9 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[5] |
| audit | PAH with vasoreactivity —distinct-from→ IPAH — Audit 2026-09-28: DOUBTFUL - read against its full span and kept, but attributed: the span reports what Hemnes and co-workers showed. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[6] |
| note | PAH with vasoreactivity —distinct-from→ IPAH — 'PAH with vasoreactivity was…' The subgroup is created because 'These results…'. A class created by treatment response and then corroborated molecularly - the reverse of the usual order, and the paper is candid that 'Pathophysiology of…' Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[6] |
| relation | PAH with vasoreactivity —distinct-from→ IPAH — long-term calcium-channel-blocker responders differ from idiopathic PAH in blood signature and gene variants as well as in prognosis, which is the case for making them a subgroup Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[6] |
| weight | PAH with vasoreactivity —distinct-from→ IPAH — 0.95 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[6] |
| note | borderline mPAP —contrasted-with→ mPAP ≤20 mmHg — 'PATIENTS WITH SO-CALLED…' The comparison is between two bands of one continuous variable, and it is the only kind of evidence that can move a threshold: show that the excluded side already behaves like the included one Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[7] |
| relation | borderline mPAP —contrasted-with→ mPAP ≤20 mmHg — patients in the 21-24 mmHg band progressed to overt disease far more often than those below 20 mmHg - the empirical case that the old boundary was in the wrong place Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[7] |
| weight | borderline mPAP —contrasted-with→ mPAP ≤20 mmHg — 0.95 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[7] |
| note | drugs with data based on outbreaks, epidemiological case–control studies or large multicentre series —part-of→ Definite association — `'DEFINITE ASSOCIATION' INCLUDES DRUGS WITH DATA BASED ON OUTBREAKS, EPIDEMIOLOGICAL CASE-CONTROL STUDIES OR LARGE MULTICENTRE SERIES. 'POSSIBLE ASSOCIATION' is suggested by multiple case series or cases with drugs with similar mechanisms of action.` An evidential grade written into a classification - and note the asymmetry: mechanism similarity is enough for `possible` and never enough for `definite` Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[8] |
| relation | drugs with data based on outbreaks, epidemiological case–control studies or large multicentre series —part-of→ Definite association — whether a drug is a definite or a possible cause of PAH is decided by the study design behind the association, not by the strength of the effect or a mechanism Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[8] |
| weight | drugs with data based on outbreaks, epidemiological case–control studies or large multicentre series —part-of→ Definite association — 0.9 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concept_edges[8] |
| outcome | control — held Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | controls[0] |
| outcome | control — held Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | controls[1] |
| outcome | control — partial Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | controls[2] |
| outcome | control — held Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | controls[3] |
| limitation | THE STRONGEST SENTENCE AGAINST THE PAPER IS THE PAPER'S OWN: `This cut-off value of PVR >=3 WU is also quite arbitrary.` The abstract sells the mPAP change as `no longer arbitrary, but based on a scientific approach`; the definition it proposes requires BOTH numbers, and only one of them has been de-arbitrarised. A definition is no more principled than its least principled conjunct Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[0] |
| limitation | AND `no longer arbitrary` MEANS `A DIFFERENT CONVENTION`: mean plus two standard deviations in `1187 normal subjects from 47 studies` is a rule about how much of a healthy population to place outside normal - `above the 97.5th percentile`. It is reproducible, auditable and far better than a show of hands, and it is still a choice of tail. The paper does not claim 20 mmHg is where the pathology starts; it claims it is where the normal distribution ends Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[1] |
| limitation | AND THE NEW DIAGNOSIS COMES WITH NOTHING TO DO ABOUT IT: `Prospective trials are required to determine whether this PH population might benefit from specific management.` The task force is explicit that widening the definition `does not imply treating these additional patients` - which is the right disclosure, and leaves every patient newly inside the boundary with a disease name and a monitoring plan Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[2] |
| limitation | AND THE OVERDIAGNOSIS ARGUMENT IS ANSWERED BY REDIRECTING IT: `For many years, the diagnosis of PH was based on an arbitrary value ... probably because of understandable concern about overdiagnosis and overtreatment. Actually, the main cause of overdiagnosis ... is the failure to confirm the diagnosis by RHC.` The reply is that overdiagnosis comes from skipping the catheter rather than from where the line sits - true, and it does not measure how many more people the new line admits, which this paper does not estimate Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[3] |
| limitation | AND THE DISCLOSURES ARE DENSE AND UNIFORM: `Conflict of interest: G. Simonneau reports grants, personal fees and non-financial support from Actelion Pharmaceuticals, Bayer Healthcare, Merck and GSK, outside the submitted work.` Seven of the eight authors file a comparable statement, most naming Actelion. Every one is declared, none is hidden, and a task force that widens a disease boundary is advised by people paid by the manufacturers of its treatments - which is a fact about the field's structure, not an allegation about this paper Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | limitations[4] |
finding · quantity · variable · definition · key-term — grounded in the full text| finding | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[0] |
| finding | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[1] |
| finding | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[2] |
| finding | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[3] |
| finding | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[4] |
| finding | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[5] |
| finding | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[6] |
| finding | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[7] |
| finding | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[8] |
| finding | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.findings[9] |
| quantity | mPAP >=25 mmHg (since 1973) -> mPAP >20 mmHg (upper limit of normal) — Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[0] |
| quantity | mPAP 14.0 +/- 3.3 mmHg in 1187 normal subjects from 47 studies — Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[1] |
| quantity | PVR >=3 Wood Units - `also quite arbitrary`, with `PVR >2 WU` suggested by recent data — Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[2] |
| quantity | 16 of 38 (42%) systemic sclerosis patients at mPAP 21-24 mmHg developed overt PH — Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[3] |
| quantity | PAWP <=15 mmHg; exercise mPAP >30 mmHg (2004, removed 2008, not restored) — Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.quantities[4] |
| variable | pulmonary vascular resistance Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.variables[0] |
| variable | pulmonary arterial wedge pressure (PAWP) Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.variables[1] |
| variable | right heart catheterisation (RHC) Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.variables[2] |
| definition | pulmonary hypertension Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[0] |
| definition | pre-capillary PH Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[1] |
| definition | upper limit of normal mPAP Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[2] |
| definition | acute vasodilator response Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[3] |
| definition | group 5 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.definitions[4] |
| concept | pulmonary hypertension (PH) — not defined in this paper's own words; the disease whose defining threshold this paper moves Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[0] |
| concept | mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest — not defined in this paper's own words; the 1973 definition, in force until this paper Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[1] |
| concept | Pre-capillary PH — not defined in this paper's own words; the form of PH that indicates pulmonary vascular disease Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[2] |
| concept | mPAP >20 mmHg, PAWP ≤15 mmHg and PVR ≥3 WU — not defined in this paper's own words; the three simultaneous conditions proposed in 2018 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[3] |
| concept | PAP elevation — not defined in this paper's own words; the measured quantity, which several unrelated processes can raise Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[4] |
| concept | increase in cardiac output — not defined in this paper's own words; one of the non-vascular causes that makes the pressure alone uninterpretable Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[5] |
| concept | LHD — not defined in this paper's own words; left heart disease - the commonest cause of resting PH Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[6] |
| concept | PVD — not defined in this paper's own words; pulmonary vascular disease - what the definition is trying to identify Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[7] |
| concept | PAH — not defined in this paper's own words; pulmonary arterial hypertension, group 1 Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[8] |
| concept | PVOD/PCH — not defined in this paper's own words; pulmonary veno-occlusive disease / pulmonary capillary haemangiomatosis, until now a distinct subgroup Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[9] |
| concept | group 5 — not defined in this paper's own words; the residual class, defined by absent evidence Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[10] |
| concept | forms of PH with unclear and/or multifactorial mechanisms — not defined in this paper's own words; what group 5 contains, and the phrase that now names it Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[11] |
| concept | PAH with vasoreactivity — not defined in this paper's own words; the subgroup that responds long-term to calcium channel blockers Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[12] |
| concept | IPAH — not defined in this paper's own words; idiopathic PAH - the comparison class Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[13] |
| concept | borderline mPAP — not defined in this paper's own words; 21-24 mmHg: above normal, below the old definition Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[14] |
| concept | mPAP ≤20 mmHg — not defined in this paper's own words; the band the new definition still calls normal Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[15] |
| concept | Definite association — not defined in this paper's own words; the higher of two evidence grades for a drug causing PAH Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[16] |
| concept | drugs with data based on outbreaks, epidemiological case–control studies or large multicentre series — not defined in this paper's own words; what a 'definite' association is made of - study designs, not mechanisms Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | concepts[17] |
| mean plus two standard deviations, doing the work of a disease boundary | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.statistics[0] |
| hazard ratios as the argument for moving a threshold | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.statistics[1] |
| 36% of the borderline band already meet the new resistance criterion | Quotation withheld — this paper is not ours to reproduce, and the page has already quoted as much of it as the rights layer allows. The tag, its field and its confidence stand; the sentence is at the publisher. | content_tags.statistics[2] |
When we have changed our mind. Some entries in the table begin with a word in capitals and the reason for it. EVIDENCE CORRECTED — the finding still stands, but we had quoted the wrong sentence from the paper, and the quotation has been replaced with the right one. RETRACTED — the entry itself was wrong; it stays on the page, marked, with the reason, rather than being deleted. WITHDRAWN AND REPLACED — the entry was wrong, and a corrected version of it appears in the entries below. Each mark carries its own reason, in brackets, because the reasons differ from one entry to the next. An entry we have WITHDRAWN is removed from this page and kept in the record, with its reason. A line reading Audit and a date is a later re-reading of the entry against its whole sentence: DOUBTFUL means it was kept, and the reason says what is loose about it. Quotation marks inside the tagger's sentence. Where a tag is the tagger's own sentence, a phrase in quotation marks inside it is borrowed from the paper — the tagger's wording around it is not. The paper's own sentence is the evidence quote for that row; on this page it is withheld with the article, and the article is at its publisher. Nothing inside quotation marks anywhere on this page is ours: if it is quoted, it is the paper's. Whose words a concept carries. A concept entry records a term the paper itself uses, so the term, the sense given for it, and its evidence are the paper's own words, quoted where the paper fixes them. This is the opposite of a sense entry in the tag table, which is the tagger's sentence about how the paper uses a term. Where a concept entry could not be grounded in the paper's words, the entry says so on its own row.
Tag layer © the Meta-Tagging Project, CC BY 4.0. The paper text is © its authors/publisher
and is linked, not reproduced. Excerpts shown are short quotations for identification and verification.
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