Table 1_Pressure-flow discordance in perioperative pulmonary hypertension: a mechanism-based review and provisional five-domain right-heart model for noncardiac surgery.docx

Evidence provenance is labeled as guideline or consensus, direct perioperative clinical data, extrapolated physiologic or critical-care evidence, or an unvalidated framework hypothesis. A measurement hierarchy separates quantitative cardiac-output estimates from stroke-volume trends and from downstream perfusion surrogates. Provisional classification requires a core directional pattern plus corroboration from independent domains and permits mixed or indeterminate states.

Disease group remains decisive because the same trajectory may imply different hazards in precapillary, postcapillary, lung-disease, or thromboembolic pulmonary hypertension. During controlled instability, one small matched intervention can test the working mechanism; during immediately life-threatening deterioration, parallel resuscitative actions take precedence. The proposed model must demonstrate reproducible classification and incremental value beyond contemporary clinical risk assessment, right-ventricular function, biomarkers, procedure characteristics, and conventional monitoring before it is used as a treatment algorithm.</p>