Treatment goals of pulmonary hypertension.

Hdl Handle:
http://hdl.handle.net/10147/313500
Title:
Treatment goals of pulmonary hypertension.
Authors:
McLaughlin, Vallerie V; Gaine, Sean Patrick; Howard, Luke S; Leuchte, Hanno H; Mathier, Michael A; Mehta, Sanjay; Palazzini, Massimillano; Park, Myung H; Tapson, Victor F; Sitbon, Olivier
Citation:
Treatment goals of pulmonary hypertension. 2013, 62 (25 Suppl):D73-81 J. Am. Coll. Cardiol.
Journal:
Journal of the American College of Cardiology
Issue Date:
24-Dec-2013
URI:
http://hdl.handle.net/10147/313500
DOI:
10.1016/j.jacc.2013.10.034
PubMed ID:
24355644
Abstract:
With significant therapeutic advances in the field of pulmonary arterial hypertension, the need to identify clinically relevant treatment goals that correlate with long-term outcome has emerged as 1 of the most critical tasks. Current goals include achieving modified New York Heart Association functional class I or II, 6-min walk distance >380 m, normalization of right ventricular size and function on echocardiograph, a decreasing or normalization of B-type natriuretic peptide (BNP), and hemodynamics with right atrial pressure <8 mm Hg and cardiac index >2.5 mg/kg/min(2). However, to more effectively prognosticate in the current era of complex treatments, it is becoming clear that the "bar" needs to be set higher, with more robust and clearer delineations aimed at parameters that correlate with long-term outcome; namely, exercise capacity and right heart function. Specifically, tests that accurately and noninvasively determine right ventricular function, such as cardiac magnetic resonance imaging and BNP/N-terminal pro-B-type natriuretic peptide, are emerging as promising indicators to serve as baseline predictors and treatment targets. Furthermore, studies focusing on outcomes have shown that no single test can reliably serve as a long-term prognostic marker and that composite treatment goals are more predictive of long-term outcome. It has been proposed that treatment goals be revised to include the following: modified New York Heart Association functional class I or II, 6-min walk distance ≥ 380 to 440 m, cardiopulmonary exercise test-measured peak oxygen consumption >15 ml/min/kg and ventilatory equivalent for carbon dioxide <45 l/min/l/min, BNP level toward "normal," echocardiograph and/or cardiac magnetic resonance imaging demonstrating normal/near-normal right ventricular size and function, and hemodynamics showing normalization of right ventricular function with right atrial pressure <8 mm Hg and cardiac index >2.5 to 3.0 l/min/m(2).
Language:
en
Local subject classification:
PULMONARY ARTERIAL HYPERTENSION
ISSN:
1558-3597

Full metadata record

DC FieldValue Language
dc.contributor.authorMcLaughlin, Vallerie Ven_GB
dc.contributor.authorGaine, Sean Patricken_GB
dc.contributor.authorHoward, Luke Sen_GB
dc.contributor.authorLeuchte, Hanno Hen_GB
dc.contributor.authorMathier, Michael Aen_GB
dc.contributor.authorMehta, Sanjayen_GB
dc.contributor.authorPalazzini, Massimillanoen_GB
dc.contributor.authorPark, Myung Hen_GB
dc.contributor.authorTapson, Victor Fen_GB
dc.contributor.authorSitbon, Olivieren_GB
dc.date.accessioned2014-02-28T14:46:06Z-
dc.date.available2014-02-28T14:46:06Z-
dc.date.issued2013-12-24-
dc.identifier.citationTreatment goals of pulmonary hypertension. 2013, 62 (25 Suppl):D73-81 J. Am. Coll. Cardiol.en_GB
dc.identifier.issn1558-3597-
dc.identifier.pmid24355644-
dc.identifier.doi10.1016/j.jacc.2013.10.034-
dc.identifier.urihttp://hdl.handle.net/10147/313500-
dc.description.abstractWith significant therapeutic advances in the field of pulmonary arterial hypertension, the need to identify clinically relevant treatment goals that correlate with long-term outcome has emerged as 1 of the most critical tasks. Current goals include achieving modified New York Heart Association functional class I or II, 6-min walk distance >380 m, normalization of right ventricular size and function on echocardiograph, a decreasing or normalization of B-type natriuretic peptide (BNP), and hemodynamics with right atrial pressure <8 mm Hg and cardiac index >2.5 mg/kg/min(2). However, to more effectively prognosticate in the current era of complex treatments, it is becoming clear that the "bar" needs to be set higher, with more robust and clearer delineations aimed at parameters that correlate with long-term outcome; namely, exercise capacity and right heart function. Specifically, tests that accurately and noninvasively determine right ventricular function, such as cardiac magnetic resonance imaging and BNP/N-terminal pro-B-type natriuretic peptide, are emerging as promising indicators to serve as baseline predictors and treatment targets. Furthermore, studies focusing on outcomes have shown that no single test can reliably serve as a long-term prognostic marker and that composite treatment goals are more predictive of long-term outcome. It has been proposed that treatment goals be revised to include the following: modified New York Heart Association functional class I or II, 6-min walk distance ≥ 380 to 440 m, cardiopulmonary exercise test-measured peak oxygen consumption >15 ml/min/kg and ventilatory equivalent for carbon dioxide <45 l/min/l/min, BNP level toward "normal," echocardiograph and/or cardiac magnetic resonance imaging demonstrating normal/near-normal right ventricular size and function, and hemodynamics showing normalization of right ventricular function with right atrial pressure <8 mm Hg and cardiac index >2.5 to 3.0 l/min/m(2).en_GB
dc.language.isoenen
dc.rightsArchived with thanks to Journal of the American College of Cardiologyen_GB
dc.subject.otherPULMONARY ARTERIAL HYPERTENSIONen_GB
dc.titleTreatment goals of pulmonary hypertension.en_GB
dc.identifier.journalJournal of the American College of Cardiologyen_GB
dc.description.fundingNo fundingen
dc.description.provinceLeinsteren
dc.description.peer-reviewpeer-reviewen

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