The value of tools to assess pulmonary arterial hypertension

Abstract

Pulmonary hypertension is a common but complex clinical problem. When suspected in an appropriate clinical setting or detected incidetally, an array of investigative tools are employed with an intent to confirm the diagnosis, define aetiology, evaluate the functional and haemodynamic impairment, define treatment options, monitor the therapy, and establish long-term prognosis. However, no single tool provides comprehensive information that encompasses the aforementioned aims. Therefore, judicious use of these tools is of paramount importance, in order to maximise outcome and cost-effectiveness, while minimising risks and redundancies. Furthermore, a number of promising tools and techniques are emerging rapidly in the arena of pulmonary hypertension. These tools augment our understanding of pathophysiology and natural history of pulmonary hypertension. There is, therefore, increasing need for validating these emerging paradigms in multicentre trials. In this review, we focus on the tools commonly used to evaluate pulmonary arterial hyertension and also define some of the new approaches to pulmonary arterial hypertension.

Progressive right ventricular functional and structural changes in a mouse model of pulmonary arterial hypertension

“…This suggests that in an early or mild stage of the disease, the RV adapts to preserve efficiency; but as disease progresses and becomes more severe, neither remodeling nor increased contractility allows the RV to meet the increasing demands. Subsequently, hemodynamic coupling efficiency decreases, as observed in patients with PAH previously (Kuehne et al 2004; Gupta et al 2011; Sanz et al 2012). The lower E es / E a may be indicative of maladaptive RV remodeling, which awaits further investigation.…”

TGF beta and IL13 in schistosomiasis mansoni associated pulmonary arterial hypertension; a descriptive study with comparative groups

“…Catheterization was performed in the right and left chambers of the aorta, and manometry was conducted on the left ventricle, pulmonary artery, right ventricle and right atrium using a 06-French pigtail catheter and a 07-French wedge catheter for the occluded capillary wedge pressure. The output and resistance calculations were performed using the Fick method [32]. …”

Baseline NT-proBNP correlates with change in 6-minute walk distance in patients with pulmonary arterial hypertension in the pivotal inhaled treprostinil study TRIUMPH-1

“…18 Utility of NT-proBNP levels as a useful ancillary marker of disease response in PAH trials appears to be increasingly accepted. 19 …”