AuthorsMcLaughlin, Vallerie V
Gaine, Sean Patrick
Howard, Luke S
Leuchte, Hanno H
Mathier, Michael A
Park, Myung H
Tapson, Victor F
Local subject classificationPULMONARY ARTERIAL HYPERTENSION
MetadataShow full item record
CitationTreatment goals of pulmonary hypertension. 2013, 62 (25 Suppl):D73-81 J. Am. Coll. Cardiol.
JournalJournal of the American College of Cardiology
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).
- [Treatment goals of pulmonary hypertension].
- Authors: McLaughlin VV, Gaine SP, Howard LS, Leuchte HH, Mathier MA, Mehta S, Palazzini M, Park MH, Tapson VF, Sitbon O
- Issue date: 2014 Oct
- Submaximal exercise testing may be superior to the 6-min walk test in assessing pulmonary arterial hypertension disease severity.
- Authors: Neal JE, Lee AS, Burger CD
- Issue date: 2014 Oct
- Pulsatile haemodynamic parameters are predictors of survival in paediatric pulmonary arterial hypertension.
- Authors: Douwes JM, Roofthooft MT, Bartelds B, Talsma MD, Hillege HL, Berger RM
- Issue date: 2013 Sep 30
- Definitions and diagnosis of pulmonary hypertension.
- Authors: Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, Langleben D, Manes A, Satoh T, Torres F, Wilkins MR, Badesch DB
- Issue date: 2013 Dec 24
- Prognostic value of cardiac magnetic resonance imaging for idiopathic pulmonary arterial hypertension before initiating intravenous prostacyclin therapy.
- Authors: Yamada Y, Okuda S, Kataoka M, Tanimoto A, Tamura Y, Abe T, Okamura T, Fukuda K, Satoh T, Kuribayashi S
- Issue date: 2012