Archives of the
Turkish Society of Cardiology
Review - General

Treatment goals of pulmonary hypertension

1.

Michigan Sağlık Sistemi Üniversitesi, Kardiyovasküler Tıp Bölümü, Ann Arbor, Michigan, ABD

2.

Mater Misericordiae Üniversite Hastanesi, Pulmonoloji Bölümü, Dublin, İrlanda

3.

Ulusal Kalp ve Akciğer Enstitüsü, Hammersmith Hastanesi, Ulusal Pulmoner Hipertansiyon Servisi, Londra, İngiltere

4.

Ludwig-Maximilians-Universitesi, Klinikum Grosshadern, Pulmoner Hastalık Bölümü, Münih, Almanya

5.

Pittsburgh Tıp Merkezi Üniversitesi, Pulmoner Hipertansiyon Programı, Kalp ve Vasküler Enstitüsü, Pittsburgh, Pennsylvania, ABD

6.

Londra Sağlık Bilimleri Merkezi-Victoria Hastanesi, Western Üniversitesi, Respiroloji Bölümü, Londra, Ontario, Kanada

7.

Bolonya Üniversite Hastanesi, Deneysel, Diyagnostik ve Uzmanlık Tıbbı, Bolonya, Italya

8.

Maryland Tıp Okulu Üniversitesi, Kardiyoloji Bölümü, Baltimore, Maryland, ABD

9.

Duke Universitesi Tıp Merkezi, Durham, Kuzey Carolina, ABD

10.

Paris-Sud Üniversitesi, AP-HP, CHU de Bicêtre, INSERM U999, Le Kremlin-Bicêtre, Fransa

Archives of the Turkish Society of Cardiology 2014; 42: Supplement 95-105
Read: 421 Downloads: 145 Published: 01 July 2021

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.

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ISSN 1016-5169 EISSN 1308-4488