Περίληψη:
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. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Συγγραφείς:
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, Jørn
Conde Camacho, Rafael Enrique
D'Alto, Michele
Farber, Harrison W.
Ford, H. James
Frantz, Robert P.
Ghio, Stefano
Gomberg-Maitland, Mardi
Humbert, Marc
Naeije, Robert
Orfanos, Stylianos E.
Oudiz, Ronald J.
Perrone, Sergio V.
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
Λέξεις-κλειδιά:
combination therapy, prostacyclin, pulmonary arterial hypertension, pulmonary arterial pressure, right ventricular afterload
