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 selfperpetuating injury of pulmonary vascular disease in pulmonary arterial hypertension and could translate into improved longterm 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.

Aggressive afterload lowering to improve the right ventricle a new target for medical therapy in pulmonary arterial hypertension / Vizza, C. D.; Lang, I. M.; Badagliacca, R.; Benza, R. L.; Rosenkranz, S.; White, R. J.; Adir, Y.; Andreassen, A. K.; Balasubramanian, V.; Bartolome, S.; Blanco, I.; Bourge, R. C.; Carlsen, J.; Camacho, R. E. C.; D'Alto, M.; Farber, H. W.; Frantz, R. P.; Ford, H. J.; Ghio, S.; Gomberg-Maitlan, M.; Humbert, M.; Naeije, R.; Orfanos, S. E.; Oudiz, R. J.; Perrone, S. V.; Shlobin, O. A.; Simon, M. A.; Sitbon, O.; Torres, F.; Vachiery, J. L.; Wang, K. -Y.; Yacoub, M. H.; Liu, Y.; Golden, G.; Matsubara, H.. - In: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. - ISSN 1073-449X. - 205:7(2022), pp. 751-760. [10.1164/rccm.202109-2079PP]

Aggressive afterload lowering to improve the right ventricle a new target for medical therapy in pulmonary arterial hypertension

Vizza C. D.
;
Badagliacca R.;Carlsen J.;Humbert M.;
2022

Abstract

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 selfperpetuating injury of pulmonary vascular disease in pulmonary arterial hypertension and could translate into improved longterm 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.
2022
combination therapy; prostacyclin; pulmonary arterial hypertension; pulmonary arterial pressure; right ventricular afterload; heart ventricles; humans; middle aged; pulmonary artery; retrospective studies; ventricular function, right; hypertension, pulmonary; pulmonary arterial hypertension; ventricular dysfunction, right
01 Pubblicazione su rivista::01a Articolo in rivista
Aggressive afterload lowering to improve the right ventricle a new target for medical therapy in pulmonary arterial hypertension / Vizza, C. D.; Lang, I. M.; Badagliacca, R.; Benza, R. L.; Rosenkranz, S.; White, R. J.; Adir, Y.; Andreassen, A. K.; Balasubramanian, V.; Bartolome, S.; Blanco, I.; Bourge, R. C.; Carlsen, J.; Camacho, R. E. C.; D'Alto, M.; Farber, H. W.; Frantz, R. P.; Ford, H. J.; Ghio, S.; Gomberg-Maitlan, M.; Humbert, M.; Naeije, R.; Orfanos, S. E.; Oudiz, R. J.; Perrone, S. V.; Shlobin, O. A.; Simon, M. A.; Sitbon, O.; Torres, F.; Vachiery, J. L.; Wang, K. -Y.; Yacoub, M. H.; Liu, Y.; Golden, G.; Matsubara, H.. - In: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. - ISSN 1073-449X. - 205:7(2022), pp. 751-760. [10.1164/rccm.202109-2079PP]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1634352
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