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Archives of the Turkish Society of Cardiology
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Treatment goals of pulmonary hypertension [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2014; 42(1): 95-105

Treatment goals of pulmonary hypertension

Vallerie V. Mclaughlin1, Sean Patrick Gaine2, Luke S. Howard3, Hanno H. Leuchte4, Michael A. Mathier5, Sanjay Mehta6, Massimillano Palazzini7, Myung H. Park8, Victor F. Tapson9, Olivier Sitbon10
1University of Michigan Health System, Department of Cardiovascular Medicine, Ann Arbor, Michigan, USA
2Mater Misericordiae University Hospital, Department of Pulmonology, Dublin, Ireland
3National Heart and Lung Institute, Hammersmith Hospital, National Pulmonary Hypertension Service, London, England
4Ludwig-Maximilians-University, Klinikum Grosshadern, Department of Pulmonary Diseases, Munich, Germany
5University of Pittsburgh Medical Center, Pulmonary Hypertension Program, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
6London Health Sciences Centre-Victoria Hospital, Western University, Respiroloj Department, London, Ontario, Canada
7Bologna University Hospital, Experimental, Diagnostic and Specialty Medicine, Bologna, Italy
8University of Maryland School of Medicine, Cardiology Division, Baltimore, Maryland, USA
9Duke University Medical Center, Durham, North Carolina, USA
10Paris-Sud University, AP-HP, CHU de Bicêtre, INSERM U999, Le Kremlin-Bicetre, France

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 L/dk/m2. 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/m2. (J Am Coll Cardiol 2013;62: D73–81) ©2013 by the American College of Cardiology Foundation.

Keywords: 6-min walk distance, hemodynamics, pulmonary arterial hypertension, right ventricular function

How to cite this article
Vallerie V. Mclaughlin, Sean Patrick Gaine, Luke S. Howard, Hanno H. Leuchte, Michael A. Mathier, Sanjay Mehta, Massimillano Palazzini, Myung H. Park, Victor F. Tapson, Olivier Sitbon. Treatment goals of pulmonary hypertension. Turk Kardiyol Dern Ars. 2014; 42(1): 95-105

Corresponding Author: Vallerie V. Mclaughlin, United States
Manuscript Language: Turkish


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