Aggressive Afterload Lowering to Improve the Right Ventricle A New Target for Medical Therapy in Pulmonary Arterial Hypertension?
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Aggressive Afterload Lowering to Improve the Right Ventricle A New Target for Medical Therapy in Pulmonary Arterial Hypertension? / Vizza, Carmine Dario; Lang, Irene M.; Badagliacca, Roberto; Benza, Raymond L.; Rosenkranz, Stephan; White, R. James; Adir, Yochai; Andreassen, Arne K.; Balasubramanian, Vijay; Bartolome, Sonja; Blanco, Isabel; Bourge, Robert C.; Carlsen, Jorn; Conde Camacho, Rafael Enrique; D'Alto, Michele; Farber, Harrison W.; Frantz, Robert P.; Ford, H. James; Ghio, Stefano; Gomberg-Maitland, Mardi; Humbert, Marc; Naeije, Robert; Orfanos, Stylianos E.; Oudiz, Ronald J.; Perrone, Sergio; Shlobin, Oksana A.; Simon, Marc A.; Sitbon, Olivier; Torres, Fernando; Vachiery, Jean Luc; Wang, Kuo-Yang; Yacoub, Magdi H.; Liu, Yan; Golden, Gil; Matsubara, Hiromi.
I: American Journal of Respiratory and Critical Care Medicine, Bind 205, Nr. 7, 2022, s. 751-760.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Aggressive Afterload Lowering to Improve the Right Ventricle A New Target for Medical Therapy in Pulmonary Arterial Hypertension?
AU - Vizza, Carmine Dario
AU - Lang, Irene M.
AU - Badagliacca, Roberto
AU - Benza, Raymond L.
AU - Rosenkranz, Stephan
AU - White, R. James
AU - Adir, Yochai
AU - Andreassen, Arne K.
AU - Balasubramanian, Vijay
AU - Bartolome, Sonja
AU - Blanco, Isabel
AU - Bourge, Robert C.
AU - Carlsen, Jorn
AU - Conde Camacho, Rafael Enrique
AU - D'Alto, Michele
AU - Farber, Harrison W.
AU - Frantz, Robert P.
AU - Ford, H. James
AU - Ghio, Stefano
AU - Gomberg-Maitland, Mardi
AU - Humbert, Marc
AU - Naeije, Robert
AU - Orfanos, Stylianos E.
AU - Oudiz, Ronald J.
AU - Perrone, Sergio
AU - Shlobin, Oksana A.
AU - Simon, Marc A.
AU - Sitbon, Olivier
AU - Torres, Fernando
AU - Vachiery, Jean Luc
AU - Wang, Kuo-Yang
AU - Yacoub, Magdi H.
AU - Liu, Yan
AU - Golden, Gil
AU - Matsubara, Hiromi
PY - 2022
Y1 - 2022
N2 - Despite numerous therapeutic advances in pulmonary arterial hypertension, patients continue to suffer high morbidity and mortality, particularly considering a median age of 50 years. This article explores whether early, robust reduction of right ventricular afterload would facilitate substantial improvement in right ventricular function and thus whether afterload reduction should be a treatment goal for pulmonary arterial hypertension. The earliest clinical studies of prostanoid treatment in pulmonary arterial hypertension demonstrated an important link between lowering mean pulmonary arterial pressure (or pulmonary vascular resistance) and improved survival. Subsequent studies of oral monotherapy or sequential combination therapy demonstrated smaller reductions in mean pulmonary arterial pressure and pulmonary vascular resistance. More recently, retrospective reports of initial aggressive prostanoid treatment or initial combination oral and parenteral therapy have shown marked afterload reduction along with significant improvements in right ventricular function. Some data suggest that reaching threshold levels for pressure or resistance (components of right ventricular afterload) may be key to interrupting the self-perpetuating injury of pulmonary vascular disease in pulmonary arterial hypertension and could translate into improved long-term clinical outcomes. Based on these clues, the authors postulate that improved clinical outcomes might be achieved by targeting significant afterload reduction with initial oral combination therapy and early parenteral prostanoids.
AB - Despite numerous therapeutic advances in pulmonary arterial hypertension, patients continue to suffer high morbidity and mortality, particularly considering a median age of 50 years. This article explores whether early, robust reduction of right ventricular afterload would facilitate substantial improvement in right ventricular function and thus whether afterload reduction should be a treatment goal for pulmonary arterial hypertension. The earliest clinical studies of prostanoid treatment in pulmonary arterial hypertension demonstrated an important link between lowering mean pulmonary arterial pressure (or pulmonary vascular resistance) and improved survival. Subsequent studies of oral monotherapy or sequential combination therapy demonstrated smaller reductions in mean pulmonary arterial pressure and pulmonary vascular resistance. More recently, retrospective reports of initial aggressive prostanoid treatment or initial combination oral and parenteral therapy have shown marked afterload reduction along with significant improvements in right ventricular function. Some data suggest that reaching threshold levels for pressure or resistance (components of right ventricular afterload) may be key to interrupting the self-perpetuating injury of pulmonary vascular disease in pulmonary arterial hypertension and could translate into improved long-term clinical outcomes. Based on these clues, the authors postulate that improved clinical outcomes might be achieved by targeting significant afterload reduction with initial oral combination therapy and early parenteral prostanoids.
KW - combination therapy
KW - prostacyclin
KW - pulmonary arterial hypertension
KW - pulmonary arterial pressure
KW - right ventricular afterload
KW - COMBINATION THERAPY
KW - LUNG TRANSPLANTATION
KW - PROGNOSTIC-FACTORS
KW - SINGLE-CENTER
KW - RIGHT HEART
KW - FOLLOW-UP
KW - EPOPROSTENOL
KW - PROSTACYCLIN
KW - BOSENTAN
KW - SURVIVAL
U2 - 10.1164/rccm.202109-2079PP
DO - 10.1164/rccm.202109-2079PP
M3 - Journal article
C2 - 34905704
VL - 205
SP - 751
EP - 760
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
SN - 1073-449X
IS - 7
ER -
ID: 308117253