Precision medicine in Pulmonary Hypertension

2019/09/16 22:28:54
Precision medicine in Pulmonary Hypertension

Take home messages in “Update of Pulmonary Hypertension Guideline”

1. Definition: • No diastolic PA gradient for PAH, use “PVR”
2. Classification: add
1.3 Drug- and toxin-induced PAH
1.5 PAH long-term responders to calcium channel blockers
1.6 PAH with overt features of venous/capillaries (PVOD/PCH) involvement
2.4 Congenital/acquired cardiovascular conditions leading to post-capillary PH
5.4 Developmental lung disorders
5.4 Complex cogngenital heart disease
3. Algorithm for diagnosis:
• CTEPH and Lt heart disease must to be ruled out first due to treatable and better prognosis
4. Risk assessment: • Systematic assessment for improvement using measurable parameters is important
• Patient with low risk PAH having best prognosis
(mortality < 5%/year)
5. Medication regimen: • Start medication early is benefit even functional class I or II • Using initial triple drugs therapy as fast as we can is preferred
6. Algorithm for treatment: • Find out PAH patient who response to calcium channel blockers and use the medication, cheaper and more effective
• Target is achieving “low risk PAH” (mortality < 5%/year)
• Lung (and heart) transplantation is the final hope of survival

Take home messages in “Pitfall in PAH-Specific Medical Treatment”

1. Correct(Precise) diagnosis is ESSENTIAL
2. Impact on management options and prognosis
3. PAH target ed medical therapy – not suitable for all PH patients(especially group II and III)
4. Treatment of PAH
a. Before start Rx : discuss with the patient(and family) in detail about Dx, prognosis, plan of treatment
b. Course of disease : not curable, usually will progress
c. Cost of Rx and potential side effects
d. Mention : Lung transplantation

Take home messages in “Common Mistake in Pulmonary Hypertension Diagnosis and Management”

1. Mistakes in PHT management is not uncommon.
2. Disease-awareness is the first key for early diagnosis.
3. Right heart catheterization is mandatory in PHT management for both diagnosis and risk stratification.
4. Carefully interpret every investigation.
5. Keep your knowledge update.