The Case of Lucia Nazzareno Galiè, M.D.
|
|
|
- Gavin Austin
- 5 years ago
- Views:
Transcription
1 The Case of Lucia Nazzareno Galiè, M.D. DIMES
2 Disclosures Consulting fees and research support from Actelion Pharmaceuticals Ltd, Bayer HealthCare, Eli Lilly and Co, GlaxoSmithKline and Pfizer Ltd
3 Clinical history 18 YO female Volleyball player Dyspnoea on exercise, WHO FC III Withdrew from sport after a couple of presyncope and appearance of ankle edema General Cardiology visit
4 ECG and Echocardiogram No Congenital heart Diseases RV and PA dilatation; spap 45 mmhg
5 Question 1: how would you manage this patient? 1.Program a series of investigations according with the PH guidelines 2.Start PH approved medications 3.Send urgently the patient to a PH expert center for appropriate management 4.Program a perfusion/ventilation scan 5.Program a CT angiography
6 Risk assessment in pulmonary arterial hypertension 6 Eur Heart J 2015, Eur Respir J, 2015
7 Question 1: how would you manage this patient? 1.Program a series of investigations according with the PH guidelines 2.Start PH approved medications 3.Send urgently the patient to a PH expert center for appropriate management 4.Program a perfusion/ventilation scan 5.Program a CT angiography
8 Clinical history 18 YO female Volleyball player Dyspnoea on exercise, WHO FC III Withdraw from sport after a couple of presyncope and appearance of ankle edema General Cardiology visit Going back home while climbing stairs syncopal episode > ER of Expert PH Center
9 ER Clinical Evaluation JVP > 8 cmh20 Hepatomegaly and ankle edema BP = 95/75 mmhg HR = 110 b/min RR = 25 / min SaO2 = 90 % in room air Left parasternal systolic murmur, increased P2 TC 38
10 ECG
11 Question 2: which further investigation would you require? 1.Program a series of investigations according with the PH guidelines 2.Chest radiograph 3.HRCT and CT pulmonary angiography 4.Perfusion lung scan 5.D-dimer
12 Hemodynamic management of critically ill patients with right ventricular failure The basic principles of ICU management of patients with PH and RV failure include the treatment of triggering factors (such as anaemia, arrhythmias, infections or other co-morbidities), optimization of fluid balance (usually with i.v. diuretics. improvement of CO with inotropes (with dobutamine being the preferred inotrope to treat RV failure) and maintenance of systemic blood pressure with vasopressors, if necessary.
13 Question 2: which further investigation would you require? 1.Program a series of investigations according with the PH guidelines 2.Chest radiograph 3.HRCT and CT pulmonary angiography 4.Perfusion lung scan 5.D-dimer
14 HRCT and CT pulmonary angiography
15 Clinical history Blood cultures negative Treated for non-specific infection Regression of fever and inflammatory signs Laboratory work-up for PH: negative
16 ECG/chest X-ray
17 No CHD Patent foramen ovale Pericardial effusion Echocardiogram
18 Right Heart Catheterization Baseline NO HR (b/min) RAP (mmhg) PAP s/d/m (mmhg) 85/42/62 86/41/60 PAWP (mmhg) 8 9 SAP s/d/m (mmhg) 81/63/70 81/63/70 CI (L/min/m 2 ) PVR (UR) SA O 2 % SP O 2 % WHO-FC IV IV 6MWD (meters) 0 0
19 Galie N et al Eur Heart J 2015, Eur Respir J, 2015 Risk assessment in pulmonary arterial hypertension 19
20 Question 3: which is your treatment strategy? 1.Inotropic drugs, diuretics and oxygen 2.Inotropic drugs, diuretics, oxygen and iv epoprostenol 3.Inotropic drugs, diuretics, oxygen and initial combination therapy including iv epoprostenol 4.Inotropic drugs, diuretics, oxygen and initial combination therapy 5.Balloon atrial septostomy
21 Question 3: which is your treatment strategy? 1.Inotropic drugs, diuretics and oxygen 2.Inotropic drugs, diuretics, oxygen and iv epoprostenol 3.Inotropic drugs, diuretics, oxygen and initial combination therapy including iv epoprostenol 4.Inotropic drugs, diuretics, oxygen and initial combination therapy 5.Balloon atrial septostomy
22 22 Recommendations for PAH supportive therapy Galie N et al Eur Heart J 2015, Eur Respir J, 2015
23 Recommendations for efficacy of intensive care unit management, balloon atrial septostomy and lung transplantation for PAH (Group 1) 23 Galie N et al Eur Heart J 2015, Eur Respir J, 2015
24 Treatment Algorithm for Pulmonary Arterial Hypertension 24 Galiè N. et al Eur Heart J 2015, Eur Respir J, 2015
25 ECG/Chest X-ray after one week
26 Initial Chest X-ray and after one week
27 PAH functional class IV precipitated by admission WHO FC IV JVP 15 cmh 2 O SaO 2 95% 3 l/mino 2 NT-proBNP 2000 discharge WHO FC III JVP < 8 cmh 2 O SaO 2 98% RA NT-proBNP 150 ng/l Thermostable iv epoprostenol 22 ng/kg/min Sildenafil 20 mg TID Macitentan 10 mg OD Furosemide 75 mg K canrenoate 25 mg OD
28 Right Heart Catheterization Baseline 3 months Epo+ Macitentan+ Sildenafil HR (b/min) RAP (mmhg) 15 7 PAP s/d/m (mmhg) 85/42/62 87/41/55 PAWP (mmhg) 8 6 SAP s/d/m (mmhg) 81/63/70 97/53/69 CI (L/min/m 2 ) PVR (UR) SA O 2 % SP O 2 % WHO-FC IV II 6MWD (meters) 0 575
29 Survival in overall population admitted in ICU ICU mortality 41.3% Sztrymf B.Prognostic factors of acute heart failure in patients with pulmonary arterial hypertension.
30 % change BREATHE-2: Initial dual combination therapy with epoprostenol and bosentan 6-MWD (m) TPR change from baseline (%) Baseline (mean and 95% CI) Placebo + epo (n = 10) Bos + epo (n = 18) Week 16 (median and 95% CI) Placebo + epo (n = 10) Bos + epo (n = 18) MWD (m) Placebo + epo (n = 10) Baseline Wk Bos + epo (n = 18) Baseline Wk 16-23% -36% P=0.08 Humbert M, et al. Eur Respir J. 2004;24:353-9.
31 PVR (d.s.cm -5 ) Cumulative survival (%) Initial dual combination therapy with epoprostenol and bosentan Percent change in PVR from baseline to 1 st f-up evaluation (3 6 months) Epo + bosentan combination therapy (n=23) Epoprostenol monotherapy (n=46) Epoprostenol + bosentan (n = 23) p = Epoprostenol (n = 46) 0 Baseline 4-month Baseline 3-month -48 ± 17% -29 ± 17% P= Time (months) Kemp K, et al. J Heart Lung Transplant 2012;31:150 8.
32 Initial triple combination therapy: I.V. Epoprostenol + Bosentan + Sildenafil Initial triple combo therapy: i.v. epoprostenol + bosentan + sildenafil 19 incident (i.e. newly diagnosed) patients with Idiopathic (n=9) or Heritable (n=10) PAH Mean age 39 ± 14 years (18 63) NYHA FC III (n=8) or IV (n=11) Severe haemodynamics: CI < 2.0 L/min/m 2 or PVR > 1000 d.s.cm -5 Sitbon O, et al. Eur Respir J. 2014;43:
33 Patients (n) 6MWD (m) Initial triple combination therapy: Effect on FC and 6MWD Prospective, observational analysis of idiopathic or heritable PAH patients (n = 19) treated with upfront combination therapy (epoprostenol, bosentan and sildenafil) FC I/II FC III FC IV Baseline 4 months* Last visit* # Baseline 4 months Last visit * * ** # # 32 ± 19 months *p < 0.01 versus baseline; ** p < 0.01 versus 4 months Sitbon O, et al. Eur Respir J. 2014;43:
34 mpap (mmhg) Cardiac index (l/min/m 2 ) PVR (dyn s/cm 5 ) Initial triple combination therapy: Effect on haemodynamics Baseline Month 4 Final followup visit # Baseline Month 4 Final followup visit # Baseline Month 4 Final followup visit # Baseline Month 4 Final follow-up # RAP (mmhg) 11.9 ± ± 4.9* 5.2 ± 3.5* mpap (mmhg) 65.8 ± ± 14.0* 44.4 ± 13.4* CI (l/min/m 2 ) 1.66 ± ± 0.69* 3.64 ± 0.65* PVR (d.s.cm -5 ) 1718 ± ± 260* 492 ± 209* # 32 ± 19 months *p < 0.01 versus baseline Sitbon O, et al. Eur Respir J. 2014;43:
35 Initial triple combination therapy: Long-term outcome / survival Long-term follow-up (n=19) Median follow-up: 58.7 months (IQR: months) Two patients underwent LT (after 3.8 and 41.4 months) 17 patients well and alive in NYHA FC I-II 7 patients with mpap < 35 mmhg (incl. one < 20 mmhg) Survival (n=19) 1-year 2-year 3-year 5-year Actual 100% 100% 100% 100% Expected* [95% CI] 75% [68%-82%] 60% [50%-70%] 49% [38%-60%] Transplant-free 94% 94% 94% 89% * according to the French equation (Humbert M, et al. Eur Respir J 2010) - Sitbon O, et al. Eur Respir J. 2014;43:
36 Key messages High risk PAH patients should be treated in expert PH centers ICU treatment including iv inotropic support may be required according with the clinical and haemodynamic status Initial combination therapy including iv epoprostenol is the treatment of choice for these patients
The Case of Marco Nazzareno Galiè, M.D.
The Case of Marco Nazzareno Galiè, M.D. DIMES Disclosures Consulting fees and research support from Actelion Pharmaceuticals Ltd, Bayer HealthCare, Eli Lilly and Co, GlaxoSmithKline and Pfizer Ltd Clinical
Progress in PAH. Gerald Simonneau
Progress in PAH Gerald Simonneau National Reference center for Pulmonary Hypertension Bicetre University Hospital, INSERM U 999 Paris-Sud University Le Kremlin Bicêtre France Clinical Classification of
Comparison between adult and pediatric populations with I/HPAH and PAH-CHD in the Bologna ARCA registry
nazzareno.galie@unibo.it Comparison between adult and pediatric populations with I/HPAH and PAH-CHD in the Bologna ARCA registry Nazzareno Galiè, MD, FESC, FRCP (Hon), DIMES 2 Comprehensive clinical classification
THERAPEUTICS IN PULMONARY ARTERIAL HYPERTENSION Evidences & Guidelines
THERAPEUTICS IN PULMONARY ARTERIAL HYPERTENSION Evidences & Guidelines Vu Nang Phuc, MD Dinh Duc Huy, MD Pham Nguyen Vinh, MD, PhD, FACC Tam Duc Cardiology Hospital Faculty Disclosure No conflict of interest
Pulmonary Hypertension: When to Initiate Advanced Therapy. Jonathan D. Rich, MD Associate Professor of Medicine Northwestern University
Pulmonary Hypertension: When to Initiate Advanced Therapy Jonathan D. Rich, MD Associate Professor of Medicine Northwestern University Disclosures Medtronic, Abbott: Consultant Hemodynamic Definition of
Case Presentation : Pulmonary Hypertension: Diagnosis and Imaging
Case Presentation 9.40-11.20: Pulmonary Hypertension: Diagnosis and Imaging Eftychia Demerouti MD, MSc, PhD Cardiologist Onassis Cardiac Surgery Center Conflicts of interest Consulting fees and fees for
Pulmonary arterial hypertension. Pulmonary arterial hypertension: newer therapies. Definition of PH 12/18/16. WHO Group classification of PH
Pulmonary arterial hypertension Pulmonary arterial hypertension: newer therapies Ramona L. Doyle, MD Clinical Professor of Medicine, UCSF Attending Physician UCSF PH Clinic Definition and classification
Oral Therapies for Pulmonary Arterial Hypertension
Oral Therapies for Pulmonary Arterial Hypertension Leslie Wooten, PharmD PGY2 Internal Medicine Pharmacy Resident University of Cincinnati Medical Center April 30 th, 2018 Objectives Pharmacist Objectives
Real-world experience with riociguat in CTEPH
Real-world experience with riociguat in CTEPH Matthias Held Center of Pulmonary Hypertension and Pulmonary Vascular Disease, Medical Mission Hospital, Würzburg, Germany Tuesday, 29 September ERS International
Navigating the identification, diagnosis and management of pulmonary hypertension using the updated ESC/ERS guidelines
Navigating the identification, diagnosis and management of pulmonary hypertension using the updated ESC/ERS guidelines Host: Marc Humbert Speaker: Simon Gibbs Marc HUMBERT, MD, PhD Professor of Respiratory
Pulmonary hypertension in sarcoidosis
Pulmonary hypertension in sarcoidosis Olivier SITBON Centre de Référence de l Hypertension Pulmonaire Sévère Hôpital Universitaire de Bicêtre INSERM U999 Université Paris-Sud Le Kremlin-Bicêtre France
ΔΙΑΓΝΩΣΗ ΚΑΙ ΘΕΡΑΠΕΙΑ ΤΗΣ ΧΡΟΝΙΑΣ ΘΡΟΜΒΟΕΜΒΟΛΙΚΗΣ ΥΠΕΡΤΑΣΗΣ (CTEPH)
Aristotle University of Thessaloniki Cardiology Clinic, AHEPA Hospital ΔΙΑΓΝΩΣΗ ΚΑΙ ΘΕΡΑΠΕΙΑ ΤΗΣ ΧΡΟΝΙΑΣ ΘΡΟΜΒΟΕΜΒΟΛΙΚΗΣ ΥΠΕΡΤΑΣΗΣ (CTEPH) Charalampos I. Karvounis, MD Professor of Cardiology Aristotle
Pulmonary Arterial Hypertension: The Approach to Management in 2019
Pulmonary Arterial Hypertension: The Approach to Management in 2019 Munir S. Janmohamed M.D. FACC Medical Director Mechanical Circulatory Support/Heart Failure Program Mercy General Hospital/Mercy Medical
SATELLITE SYMPOSIUM OF MSD. sgc Stimulation for the treatment of PH. Real life management of PAH: case presentation
SATELLITE SYMPOSIUM OF MSD sgc Stimulation for the treatment of PH Real life management of PAH: case presentation Eftychia Demerouti MD, MSc, PhD Cardiologist Onassis Cardiac Surgery Center Conflict of
Therapeutic approaches in P(A)H and the new ESC Guidelines
Therapeutic approaches in P(A)H and the new ESC Guidelines Jean-Luc Vachiéry, FESC Head Pulmonary Vascular Diseases and Heart Failure Clinic Hôpital Universitaire Erasme Université Libre de Bruxelles Belgium
Treatment of Paediatric Pulmonary Hypertension
Treatment of Paediatric Pulmonary Hypertension Dunbar Ivy, MD The Children s Hospital Heart Institute University of Colorado School of Medicine 1 Disclosures I have the following financial relationships
National Horizon Scanning Centre. Tadalafil for pulmonary arterial hypertension. October 2007
Tadalafil for pulmonary arterial hypertension October 2007 This technology summary is based on information available at the time of research and a limited literature search. It is not intended to be a
Πνευμονική Υπέρταση: Μια ΚΡΙΤΙΚΗ ματιά στις κλινικές μελέτες - AMBITION. Αναστασία Ανθη
Πανελλήνια Σεμινάρια Ομάδων Εργασίας 2017 k Πνευμονική Υπέρταση: Μια ΚΡΙΤΙΚΗ ματιά στις κλινικές μελέτες - AMBITION Αναστασία Ανθη Β Κλιν. Εντατικής Θεραπείας & Διακλινικό Ιατρείο Πνευμ. Υπέρτασης Π.Γ.Ν.
Prognostic value of echocardiographic parameters in patients with pulmonary arterial hypertension (PAH) treated with targeted therapies
Prognostic value of echocardiographic parameters in patients with pulmonary arterial hypertension (PAH) treated with targeted therapies E. Beciani, M. Palazzini, C. Bachetti, F. Sgro, E. Conficoni, E.
Anjali Vaidya, MD, FACC, FASE, FACP Associate Director, Pulmonary Hypertension, Right Heart Failure, Pulmonary Thromboendarterectomy Program Advanced
Anjali Vaidya, MD, FACC, FASE, FACP Associate Director, Pulmonary Hypertension, Right Heart Failure, Pulmonary Thromboendarterectomy Program Advanced Heart Failure & Cardiac Transplant Temple University
*Division of Pulmonary, Sleep, and Critical Care Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
The Relationship between NO Pathway Biomarkers and Response to Riociguat in the RESPITE Study of Patients with PAH Not Reaching Treatment Goals with Phosphodiesterase 5 Inhibitors James R Klinger,* Raymond
Cardiac Catheterization is Unnecessary in the Evaluation of Patients with Pulmonary Hypertension: CON
Cardiac Catheterization is Unnecessary in the Evaluation of Patients with Pulmonary Hypertension: CON Dunbar Ivy, MD The Children s s Hospital Heart Institute 1 Diagnostic Evaluation: Right Heart Cardiac
Πνευμονική Υπέρταση Ι.Ε. ΚΑΝΟΝΙΔΗΣ
Πνευμονική Υπέρταση Ι.Ε. ΚΑΝΟΝΙΔΗΣ PH is defined as PAPm 25 mm Hg at rest The general definition of PH remains unchanged Most of the relevant epidemiological and therapeutic studies have used the 25 mm
Effective Strategies and Clinical Updates in Pulmonary Arterial Hypertension
Effective Strategies and Clinical Updates in Pulmonary Arterial Hypertension Hap Farber Director, Pulmonary Hypertension Center Boston University School of Medicine Disclosures 1) Honoria: Actelion, Gilead,
CONUNDRUMS IN PULMONARY ARTERIAL HYPERTENSION
CONUNDRUMS IN PULMONARY ARTERIAL HYPERTENSION MOHAMMED RAFIQUE ESSOP MILPARK HOSPITAL and UNIVERSITY OF THE WITWATERSRAND POINTS FOR DISCUSSION What is the pathogenetic mechanism of PAH? Importance of
Real life management of CTEPH: patient case
2 nd International Congress on cardiovascular imaging in clinical practice k Real life management of CTEPH: patient case Anastasia Anthi Pulmonary Hypertension Clinic, Attikon University Hospital, Athens
Chronic Thromboembolic Pulmonary Hypertention CTEPH
Chronic Thromboembolic Pulmonary Hypertention CTEPH Medical Management Otto Schoch, Prof. Dr. Klinik für Pneumologie und Schlafmedizin Kantonsspital St.Gallen CTEPH: Medical Management Diagnostic aspects
Latest Results from Clinical Trials (MAESTRO)
EuroGUCH 2018 & 11 th Advanced Symposium on ACHD Munster April 2018 Latest Results from Clinical Trials (MAESTRO) Michael A Gatzoulis Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension
ACCP PAH Medical Therapy Guidelines: 2007 Update. David Badesch, MD University of Colorado School of Medicine Denver, CO
ACCP PAH Medical Therapy Guidelines: 2007 Update David Badesch, MD University of Colorado School of Medicine Denver, CO Disclosure of Commercial Interest Dr. Badesch has received grant/research support
Contreversies in the management of PH What is controversial in treatment?
Contreversies in the management of PH What is controversial in treatment? Service de Pneumologie et Réanimation National reference center for pulmonary hypertension Université Paris Sud Hôpital Antoine
Θεραπεία με βάση τη βαρύτητα ή εξαρχής επιθετική συνδυαστική θεραπεία. Φραντζέσκα Φραντζεσκάκη Πνευμονολόγος-Εντατικολόγος ΠΓΝ «ΑΤΤΙΚΟΝ»
Θεραπεία με βάση τη βαρύτητα ή εξαρχής επιθετική συνδυαστική θεραπεία Φραντζέσκα Φραντζεσκάκη Πνευμονολόγος-Εντατικολόγος ΠΓΝ «ΑΤΤΙΚΟΝ» S.Gaine and V.McLaughlin, Eur Respi Rev 2017;26 Ultimate goal of
Update in Pulmonary Arterial Hypertension
Update in Pulmonary Arterial Hypertension Michael J Sanley, MD April 12, 2018 Disclosures I have nothing to disclose 2 1 Case Presentation 67 yo male with atrial fibrillation, CLL on IVIG, presents with
Dr. Md. Rajibul Alam Prof. of Medicine Dinajpur Medical college
Dr. Md. Rajibul Alam Prof. of Medicine Dinajpur Medical college PULMONARY HYPERTENSION Difficult to diagnose early Because Not detected during routine physical examination and Even in advanced cases symptoms
Pulmonary Arterial Hypertension - Overview
Pulmonary Arterial Hypertension - Overview J. Shaun Smith, MD Co-Director, Pulmonary Vascular Disease Program Assistant Professor of Medicine Division of Pulmonary, Critical Care and Sleep Medicine The
Pulmonary Arterial Hypertension - Overview
Pulmonary Arterial Hypertension - Overview J. Shaun Smith, MD Co-Director, Pulmonary Vascular Disease Program Assistant Professor of Medicine Division of Pulmonary, Critical Care and Sleep Medicine The
ELIGIBILITY CRITERIA FOR PULMONARY ARTERIAL HYPERTENSION THERAPY
ELIGIBILITY CRITERIA FOR PULMONARY ARTERIAL HYPERTENSION THERAPY Contents Eligibility criteria for Pulmonary Arterial Hypertension therapy...2-6 Initial Application for funding of Pulmonary Arterial Hypertension
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Health Technology Appraisal. Drugs for the treatment of pulmonary arterial hypertension
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Health Technology Appraisal Drugs for the treatment of Draft remit / appraisal objective: Draft scope To appraise the clinical and cost effectiveness
Combination therapy in the treatment of pulmonary arterial hypertension 2015 update
Journal of Rare Cardiovascular Diseases 2015; 2 (4): 103 107 www.jrcd.eu REVIEW ARTICLE Rare diseases of pulmonary circulation Combination therapy in the treatment of pulmonary arterial hypertension 2015
Pulmonary hypertension on. Simon MacDonald BSc(Hons) BMBCh DPhil FRCP Consultant Cardiologist in Adult Congenital Heart Disease
Pulmonary hypertension on echowhat next.? Simon MacDonald BSc(Hons) BMBCh DPhil FRCP Consultant Cardiologist in Adult Congenital Heart Disease Definition of PAH Mean PA pressure 25mmHg Precapillary if
Φαρµακοθεραπεία στη Πνευµονική Αρτηριακή Υπέρταση: Αρχική ή διαδοχική συνδυαστική θεραπεία
37 ο Πανελλήνιο Καρδιολογικό Συνέδριο Αθήνα, Οκτώβριος 2016 k Φαρµακοθεραπεία στη Πνευµονική Αρτηριακή Υπέρταση: Αρχική ή διαδοχική συνδυαστική θεραπεία Αναστασία Ανθη Β Κλιν. Εντατικής Θεραπείας & Διακλινικό
Teaching Round Claudio Sartori
Teaching Round 14.03.2017 Claudio Sartori Cas clinique Femme 47 ans, connue pour un BPCO, asthénie, douleurs thoraciques, dyspnée à l effort, œdèmes membres inférieurs, deux syncopes. Tabac, BMI 31 kg/m2
Anjali Vaidya, MD, FACC, FASE, FACP Associate Director, Pulmonary Hypertension, Right Heart Failure, and Pulmonary Thromboendarterectomy Program
Anjali Vaidya, MD, FACC, FASE, FACP Associate Director, Pulmonary Hypertension, Right Heart Failure, and Pulmonary Thromboendarterectomy Program Advanced Heart Failure & Cardiac Transplant Temple University
Squeeze, Squeeze, Squeeze: The Importance of Right Ventricular Function and PH
Squeeze, Squeeze, Squeeze: The Importance of Right Ventricular Function and PH Javier Jimenez MD PhD FACC Director, Advanced Heart Failure and Pulmonary Hypertension Miami Cardiac & Vascular Institute
STARTS-1 and -2. Barst R, Ivy DD, et al. Circulation 2012;125:
STARTS-1 and -2 A randomized, double-blind,16 week placebo controlled, dose ranging, parallel group study of oral monotherapy sildenafil in treatment naive children, aged 1-17 years, with pulmonary arterial
Nothing to Disclose. Severe Pulmonary Hypertension
Severe Ronald Pearl, MD, PhD Professor and Chair Department of Anesthesiology Stanford University Rpearl@stanford.edu Nothing to Disclose 65 year old female Elective knee surgery NYHA Class 3 Aortic stenosis
Where are we now in the longterm. of PAH and CTEPH? Hits and misses of medical treatment. Hap Farber Boston University School of Medicine, Boston, USA
Where are we now in the longterm management of PAH and CTEPH? Hits and misses of medical treatment Hap Farber Boston University School of Medicine, Boston, USA Monday, 28 September ERS International Congress
Updates in Pulmonary Hypertension Pharmacotherapy. Ziad Sadik PharmD BCPS
Updates in Pulmonary Hypertension Pharmacotherapy Ziad Sadik PharmD BCPS Disclosure Information I have no financial relationship to disclose AND I will not discuss off label use and/or investigational
Pharmacy Management Drug Policy
SUBJECT: Pulmonary Arterial Hypertension (PAH) POLICY NUMBER: Pharmacy-42 Clinical criteria used to make utilization review decisions are based on credible scientific evidence published in peer reviewed
Precision medicine and personalising therapy in pulmonary hypertension: seeing the light from the dawn of a new era.
1. Eur Respir Rev. 2018 Apr 13;27(148). pii: 180004. doi: 10.1183/16000617.0004-2018. Print 2018 Jun 30. Precision medicine and personalising therapy in pulmonary hypertension: seeing the light from the
Raymond L. Benza, MD, a Mardi Gomberg-Maitland, MD, MSc, b Robert Naeije, MD, PhD, c Carl P. Arneson, MStat, d and Irene M.
http://www.jhltonline.org Prognostic factors associated with increased survival in patients with pulmonary arterial hypertension treated with subcutaneous treprostinil in randomized, placebo-controlled
PULMONARY HYPERTENSION
PULMONARY HYPERTENSION REVIEW & UPDATE Olga M. Fortenko, M.D. Pulmonary & Critical Care Medicine Pulmonary Vascular Diseases Sequoia Hospital 650-216-9000 Olga.Fortenko@dignityhealth.org Disclosures None
Protocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year
![Protocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year](/thumbs/76/74263761.jpg "Protocol Identifier Subject Identifier Visit Description. [Y] Yes [N] No. [Y] Yes [N] N. If Yes, admission date and time: Day Month Year")
PAST MEDICAL HISTORY Has the subject had a prior episode of heart failure? o Does the subject have a prior history of exposure to cardiotoxins, such as anthracyclines? URGENT HEART FAILURE VISIT Did heart
MACITENTAN DEVELOPMENT IN CHILDREN WITH PULMONARY HYPERTENSION (PAH)
MACITENTAN DEVELOPMENT IN CHILDREN WITH PULMONARY HYPERTENSION (PAH) ORPHAN DRUG AND RARE DISEASE 11 MAY 2017 Catherine Lesage, MD, Pediatrics Program Head, Actelion Copyright AGENDA Pulmonary Arterial
Disclosures. Inhaled Therapy in Pediatric Pulmonary Hypertension. Inhaled Prostacyclin: Rationale. Outline
Disclosures Inhaled Therapy in Pediatric Pulmonary Hypertension The University of Colorado receives fees for Dr Ivy to be a consultant for Actelion, Gilead, Lilly, Pfizer, and United Therapeutics Dunbar
La terapia dell ipertensione arteriosa polmonare oggi
La terapia dell ipertensione arteriosa polmonare oggi PneumoTrieste 2017 Trieste 3 5 Aprile 2017 Sergio Harari U.O. di Pneumologia e UTIR Servizio di Emodinamica e Fisiopatologia Respiratoria Ospedale
Pulmonary Hypertension: Follow-up in adolescence and adults
Pulmonary Hypertension: Follow-up in adolescence and adults Helmut Baumgartner Westfälische Wilhelms-Universität Münster Adult Congenital and Valvular Heart Disease Center University of Muenster Germany
Pulmonary Hypertension: Another Use for Viagra
Pulmonary Hypertension: Another Use for Viagra Kathleen Tong, MD Director, Heart Failure Program Assistant Clinical Professor University of California, Davis Disclosures I have no financial conflicts A
Role of Combination PAH Therapies
Role of Combination PAH Therapies Ronald J. Oudiz, MD, FACP, FACC Associate Professor of Medicine, David Geffen School of Medicine at UCLA Director, Liu Center for Pulmonary Hypertension Los Angeles Biomedical
Recent Treatment of Pulmonary Artery Hypertension. Cardiology Division Yonsei University College of Medicine
Recent Treatment of Pulmonary Artery Hypertension Cardiology Division Yonsei University College of Medicine Definition Raised Pulmonary arterial pressure (PAP) WHO criteria : spap>40 mmhg NIH Criteria
Risk Stratification in Pulmonary Hypertension and Pregnancy
Risk Stratification in Pulmonary Hypertension and Pregnancy Dr Robin Condliffe Pulmonary Vascular Disease Unit Royal Hallamshire Hospital Sheffield United Kingdom Conflicts of Interest Honorararia Actelion,
Pulmonary hypertension (PH) represents
Mædica - a Journal of Clinical Medicine MAEDICA a Journal of Clinical Medicine 2014; 9(2): 198-203 CASE REPORTS Complete Therapeutical Approach in Pulmonary Arterial Hypertension: from Vasodilators to
Pulmonary Hypertension in 2012
Pulmonary Hypertension in 2012 Evan Brittain, MD December 7, 2012 Kingston, Jamaica VanderbiltHeart.com Disclosures None VanderbiltHeart.com Outline Definition and Classification of PH Hemodynamics of
CDEC FINAL RECOMMENDATION
CDEC FINAL RECOMMENDATION Macitentan (Opsumit Actelion Pharmaceuticals Canada Inc.) Indication: Pulmonary Arterial Hypertension Recommendation: The Canadian Drug Expert Committee (CDEC) recommends that
Επεμβατικές στρατηγικές στην πνευμονική υπέρταση
Επεμβατικές στρατηγικές στην πνευμονική υπέρταση Παναγιώτης Καρυοφύλλης Καρδιολόγος Ωνάσειο Καρδιοχειρουργικό Κέντρο Mortality in PAH 2015 ESC/ERS Guidelines. Treatment algorithm Since BAS is performed
Pulmonary Hypertension Due to Left Heart Disease
ACC Middle East Conference 2018 Pulmonary Hypertension Due to Left Heart Disease Ammar Chaudhary, MBChB, FRCPC Advanced Heart Failure & Transplantation King Faisal Specialist Hospital and Research Center
Clinical Commissioning Policy: Selexipag for treating pulmonary arterial hypertension (all ages)
Clinical Commissioning Policy: Selexipag for treating pulmonary arterial hypertension (all ages) NHS England Reference: 170065P 1 NHS England INFORMATION READER BOX Directorate Medical Operations and Information
Pulmonary Arterial Hypertension in Pa)ents with HIV Infec)on: New Thoughts, BeGer Outcomes
Pulmonary Arterial Hypertension in Pa)ents with HIV Infec)on: New Thoughts, BeGer Outcomes Hap Farber, MD Director, Pulmonary Hypertension Center Boston University School of Medicine Disclosures Consultant:
Advances in Pharmacotherapy of PAH
24 th Annual Advances in Heart Disease Advances in Pharmacotherapy of PAH Gabriel Gregoratos, MD 12/14/2007 UCSF Cardiology 1 Faculty Disclosure Statement for Gabriel Gregoratos, MD Nothing to disclose
Acute Vasodilator Testing in Pulmonary Hypertension: What, When, and How?
Acute Vasodilator Testing in Pulmonary Hypertension: What, When, and How? Teresa De Marco, MD University of California, San Francisco Disclosures: Grants/Research: United Therapeutics, Lung Biotechnology,
Updates on Pulmonary Hypertension Treatment
Updates on Pulmonary Hypertension Treatment Dane Mellgren, PharmD PGY-1 Pharmacy Practice Resident Hennepin County Medical Center 04/27/18 Disclosure I have no disclosures to be made regarding the content
National Horizon Scanning Centre. Oral and inhaled treprostinil for pulmonary arterial hypertension: NYHA class III. April 2008
Oral and inhaled treprostinil for pulmonary arterial hypertension: NYHA class April 2008 This technology summary is based on information available at the time of research and a limited literature search.
Eisenmenger Syndrome: A Call for Action
Cardiology Update, Davos 2013 Eisenmenger Syndrome: A Call for Action Adult Congenital Heart Centre & National Centre for Pulmonary Hypertension Royal Brompton Hospital/National Heart & Lung Institute,
Dr.Fayez EL Shaer Consultant cardiologist Assistant professor of cardiology KKUH
Pulmonary Hypertension in patients with Heart Failure with Preserved Ejection Fraction Dr.Fayez EL Shaer Consultant cardiologist Assistant professor of cardiology KKUH Recent evaluation of available data
Effectively treating patients with pulmonary hypertension: The next chapter. Lowering PAP will improve RV function in PH
Effectively treating patients with pulmonary hypertension: The next chapter Stuart Rich, M.D. Hemodynamic Progression of PAH Preclinical Symptomatic/ Stable Pulmonary Pressure Progressive/ Declining Level
Pulmonary Hypertension. Pulmonary Arterial Hypertension Diagnosis, Impact and Outcomes
Pulmonary Hypertension Pulmonary Arterial Hypertension Diagnosis, Impact and Outcomes Pulmonary Arterial Hypertension Disease of small pulmonary arteries Characteristic changes Medial hypertrophy Intimal
PFIZER INC. THERAPEUTIC AREA AND FDA APPROVED INDICATIONS: See United States Package Insert (USPI)
PFIZER INC. These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert. For publications based on this study, see associated bibliography.
Therapy Update: ERAs. Review of Mechanism. Disclosure Statements. Outline. Disclosure: Research support from United Therapeutics
1 Therapy Update: ERAs Disclosure Statements Disclosure: Research support from United Therapeutics Most of the medications discussed in this presentation are off-label usage Nidhy Varghese, MD Pulmonary
Clinical History. CHD-PAH Case: Physical Exam. Clinical History. To Repair or not to Repair?
CHD-PAH Case: To Repair or not to Repair? Erika Berman Rosenzweig, MD Columbia University, College of Physicians and Surgeons Clinical History 18 year old female had been previously well, but new murmur
Pulmonary Hypertension Perioperative Management
Pulmonary Hypertension Perioperative Management Bruce J Leone, MD Professor of Anesthesiology Chief, Neuroanesthesiology Vice Chair for Academic Affairs Mayo Clinic Jacksonville, Florida Introduction Definition
Addition of Prostanoids in Pulmonary Hypertension Deteriorating on Oral Therapy
Addition of Prostanoids in Pulmonary Hypertension Deteriorating on Oral Therapy Wouter Jacobs, MD, a Anco Boonstra, MD, PhD, a J. Tim Marcus, PhD, b Pieter E. Postmus, MD, PhD, a and Anton Vonk-Noordegraaf,
Pulmonary Arterial Hypertension: A Journey to Lung Transplant
PH GRAND ROUNDS Pulmonary Arterial Hypertension: A Journey to Lung Transplant Section Editor Deborah J. Levine, MD Bravein Amalakuhan, MD Pulmonary and Critical Care Medicine Fellow University of Texas
Effectiveness and Outcome of Pulmonary Arterial Hypertension-Specific Therapy in Japanese Patients With Pulmonary Arterial Hypertension
Circ J 2018; 82: 275 282 doi: 10.1253/circj.CJ-17-0139 ORIGINAL ARTICLE Pulmonary Circulation Effectiveness and Outcome of Pulmonary Arterial Hypertension-Specific Therapy in Japanese Patients With Pulmonary
Pulmonary Hypertension: Evolution and
Management of Pulmonary Hypertension: Evolution and Controversies VERMONT CARDIAC NETWORK SPRING CONFERENCE MAY 10, 2018 MARYELLEN ANTKOWIAK, MD, PULMONARY & CRITICAL CARE MEDICINE, UVMMC WHO classification
Tadalafil for the Treatment of Pulmonary Arterial Hypertension
Journal of the American College of Cardiology Vol. 60, No. 8, 2012 2012 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.05.004
5/30/2014. Pulmonary Hypertension PULMONARY HYPERTENSION. mean PAP > 25 mmhg at rest. Disclosure: none
Disclosure: Pulmonary Hypertension none James Ramsay MD Medical Director, CV ICU, Moffitt Hospital, UCSF PULMONARY HYPERTENSION mean PAP > 25 mmhg at rest Pulmonary Hypertension and Right Ventricular Dysfunction:
Increasing knowledge about the pathophysiology
Eur Respir Rev 27; 16: 12, 13 18 DOI: 1.1183/95918.124 CopyrightßERSJ Ltd 27 Dual endothelin receptor antagonism: setting standards in PAH M. Humbert ABSTRACT: Endothelin (ET) has emerged as a key mediator
PULMONARY HYPERTENSION RESPIRATORY & CRITICAL CARE CONFERENCE APRIL 21, 2016 LAURA G. HOOPER
PULMONARY HYPERTENSION RESPIRATORY & CRITICAL CARE CONFERENCE APRIL 21, 2016 LAURA G. HOOPER OUTLINE Brief review of WHO Group Classification Scheme Subgroups we ll focus on: WHO Group I Pulmonary Arterial
Pulmonary Hypertension: Clinical Features & Recent Advances
Pulmonary Hypertension: Clinical Features & Recent Advances Lisa J. Rose-Jones, MD Assistant Professor of Medicine, Division of Cardiology Advanced Heart Failure/Cardiac Transplantation & Pulmonary Hypertension
Screening for CETPH after acute pulmonary embolism: is it needed? Menno V. Huisman Department of Vascular Medicine LUMC Leiden
Screening for CETPH after acute pulmonary embolism: is it needed? Menno V. Huisman Department of Vascular Medicine LUMC Leiden m.v.huisman@lumc.nl Background CETPH Chronic Thrombo Embolic Pulmonary Hypertension
different phenotypes
Pulmonary hypertension in scleroderma: different phenotypes UMR 995 Pr David LAUNAY, MD, PhD launayd@gmail.com Service de Médecine Interne. Unité d'immunologie Clinique CNRMR Maladies Systémiques et Autoimmunes
SA XXXX Special Authority for Subsidy
SA XXXX Special Authority for Subsidy Special authority approved by the Pulmonary Arterial Hypertension (PAH) Panel. Application forms can be obtained from PHARMAC s website: www.pharmac.govt.nz or: PAH
22nd Annual Heart Failure 2018 an Update on Therapy. Pulmonary Arterial Hypertension: Contemporary Approach to Treatment
22nd Annual Heart Failure 2018 an Update on Therapy Pulmonary Arterial Hypertension: Contemporary Approach to Treatment Ronald J. Oudiz, MD, FACP, FACC, FCCP Professor of Medicine The David Geffen School
IV PGI2 vs. Inhaled PGI2 in chronic lung disease
Inhaled Therapies for PAH Erika Berman Rosenzweig, MD Associate Professor of Clinical Pediatrics (in Medicine) Director, Pulmonary Hypertension Center Columbia University Medical Center Disclosures Has
Survival and Predictors of Death in Eisenmenger Syndrome
Survival and Predictors of Death in Eisenmenger Syndrome E. Romeo, M. D'Alto, P. Argiento, B. Sarubbi, G. Scognamiglio, D. Alfano, N. Grimaldi, M.G. Russo, R. Calabrò. Cardiology, Second University of
Paediatric PAH in the current era
Paediatric PAH in the current era Dunbar Ivy, MD The Children s Hospital Heart Institute University of Colorado School of Medicine Paediatric PAH in the current era & A Gap Analysis Dunbar Ivy, MD The
Update on pulmonary HTN
Update on pulmonary HTN Feras Bader, MD, MS, FACC Associate Professor of Medicine- Cardiology University of Utah School of Medicine Director, Advanced Heart Failure and Transplant Program Dabbous Cardiac
Right Heart Catheterization. Franz R. Eberli MD Chief of Cardiology Stadtspital Triemli, Zurich
Right Heart Catheterization Franz R. Eberli MD Chief of Cardiology Stadtspital Triemli, Zurich Right Heart Catheterization Pressure measurements Oxygen saturation measurements Cardiac output, Vascular
A 50-Year-Old Woman With Dyspnea, Lower Extremity Edema, and Volume Loss of the Right Hemithorax. Eugene Shostak, MD; and Akmal Sarwar, MD, FCCP
CHEST A 50-Year-Old Woman With Dyspnea, Lower Extremity Edema, and Volume Loss of the Right Hemithorax Eugene Shostak, MD; and Akmal Sarwar, MD, FCCP Postgraduate Education Corner PULMONARY AND CRITICAL
Clinical Science Working Group 6: Diagnosis & Assessment of PAH. Co-chairs: David B. Badesch, MD Marius M. Hoeper, MD. Working Group 6 Members
Clinical Science Working Group 6: Diagnosis & Assessment of PAH Co-chairs: David B. Badesch, MD Marius M. Hoeper, MD Working Group 6 Members Harm Jan Bogaard, Robin Condliffe, Robert Frantz, Dinesh Khanna,
Pulmonary Arterial Hypertension Drug Prior Authorization Protocol
Pulmonary Arterial Hypertension Drug Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review