PULMONARY HYPERTENSION IN INTERSTITIAL LUNG DISEASE
|
|
- Shona Lewis
- 5 years ago
- Views:
Transcription
1 PULMONARY HYPERTENSION IN INTERSTITIAL LUNG DISEASE STEVE NATHAN, MD DIRECTOR OF THE ADVANCED LUNG DISEASE PROGRAM INOVA FAIRFAX HOSPITAL FALLS CHURCH, VA Steven D. Nathan, MD, is the Director of the Advanced Lung Disease Program and Medical Director of the lung transplant program at Inova Fairfax Hospital in Falls Church, Virginia. He also is Professor of medicine at Virginia Commonwealth University, Inova Fairfax Campus. Dr. Nathan received his medical degree at the University of the Witwatersrand Medical School in Johannesburg, South Africa, and he completed his internship in internal medicine and general surgery at the Johannesburg Hospital. Dr. Nathan performed his internal medicine residency at Long Island Jewish Hospital in New York City, and completed his fellowships in pulmonary medicine, critical care, and lung transplantation at Cedars-Sinai Medical Center in Los Angeles, California. He is board certified in internal medicine, pulmonary diseases, and critical care medicine. Dr. Nathan has authored more than 380 publications, including original research manuscripts, abstracts, reviews and book chapters. He has also co-edited and authored two books on idiopathic pulmonary fibrosis. Dr. Nathan is a reviewer for multiple journals and is on the editorial board for the journal, Thorax. He has served on multiple committees, including the US Food and Drug Administration advisory boards as well as steering committees for clinical trials in IPF and pulmonary hypertension, where he has also served as chair. Dr. Nathan is a member of several professional medical associations, including the American Thoracic Society, the American College of Chest Physicians, and the International Society for Heart and Lung Transplantation. He has delivered talks and been chairperson of numerous sessions at many national and international conferences. OBJECTIVES: Participants should be better able to: 1. Gain knowledge about the prevalence of pulmonary hypertension (PH) complicating interstitial lung disease (ILD); 2. Appreciate the functional and prognostic implications of PH complicating ILD; 3. Develop an appreciation for indicators of underlying PH in patients with ILD; 4. Understand the potential and pitfalls of pulmonary vasoactive therapies targeting the PH of ILD. SATURDAY, MARCH 25, :00 AM
2 DISCLOSURE Dr. Nathan has received grant/research support from Boehringer Ingelheim, Bayer, Roche, and United Therapeutics; serves as a consultant for Boehringer Ingelheim, Bayer, Gilead, Roche, United Therapeutics, and Bellepharon and serves on the speakers bureau at Boehringer Ingelheim, Roche, Bayer, and Gilead, but these do not create conflicts related to his presentation. Pulmonary Hypertension in Interstitial Lung Disease Steven Nathan, MD Medical Director, Advanced Lung Disease & Transplant Program Inova Fairfax Hospital Falls Church, VA Inova Advanced Lung Disease & Transplant Program 1
3 Presenter Disclosures Steven Nathan, MD My presentation may include mention of off-label use of the following for PH in lung disease: Sildenafil Tadalafil Bosentan Ambrisentan Inhaled Iloprost Treprostinil Epoprostenol Macitentan Riociguat Clinical classification of pulmonary hypertension WHO GROUP 1 PAH Idiopathic PAH Heritable PAH o BMPR2 o ALK-1, ENG, SMAD9, CAV1, KCNK3 o Unknown Drug- and toxin-induced Associated with: o Connective tissue disease o HIV infection o Portal hypertension o Congenital heart diseases o Schistosomiasis WHO Group 1 PVOD and/or pulmonary capillary hemangiomatosis WHO Group 1 Persistent PH of the newborn WHO GROUP 2 Left-heart related Systolic dysfunction Diastolic dysfunction Valvular disease Congenital/acquired left heart inflow/outflow tract obstruction and congenital cardiomyopathies WHO GROUP 3 Lung/hypoxia related COPD ILD Other pulmonary diseases with mixed restrictive and obstructive pattern Sleep-disordered breathing Alveolar hypoventilation disorders Chronic exposure to high altitude Developmental abnormalities WHO GROUP 4 CTEPH Chronic thromboembolic pulmonary hypertension WHO GROUP 5 Unclear multifactorial mechanisms Hematologic disorders Systemic disorders Metabolic disorders Others Sarcoidosis PLCH Simonneau G et al. J Am Coll Cardiol. 2013;62(suppl):D34-D41. 2
4 Prevalence of PH in IPF Hamada, Chest (2007) Raghu, AIM (2010) Patel, Chest (2007) Song, Res Med (2009) Nathan, Chest (2007) Zisman, Chest (2007) Shorr, ERJ (2007) Minai, ISHLT (2009) Nadrous, Chest (2005) Nathan, Res Med (2008) 8% n=70 15% n=342 20% n=41 25% n=131, RVSP >40 mmhg 41% n=11 42% n=65 46% n= % n=148 39% 84% 86% n=88, RVSP >40 mmhg n= (%) IPF, idiopathic pulmonary fibrosis; RVSP, right ventricle systolic pressure. PH in Pulmonary Fibrosis & NSIP: Prevalence % of Patients % 63.6% No PH (mpap<25 mmhg) 26.8% PH (mpap25-35 mmhg) IPF (N=224) NSIP (N=33) 18.2% 18.2% 12.9% Severe PH (mpap>35 mmhg) Inova Fairfax data: August
5 Mean Pulmonary Artery Pressure: Prognostic Value in IPF Cumulative Probability to Survival P < n = 54 No (mpap 25 mm Hg) n = 25 Yes (mpap > 25 mm Hg) Years to Event 7 Chest. 2006;129: Survival curves of all subjects: stratified according to their spap level. Percent survival % 53% 24% N=131 spap <40 mmhg spap mmhg spap >60 mmhg Time (months) Song et al. Resp Med 2009;103:
6 1.0 mpap < 25; PAOP 15 COPD Probability of Survival mpap 25; PAOP 15 mpap 25; PAOP > 15 mpap < 25; PAOP > Listing Time (Days) IPF n = 54 No (mpap 25 mm Hg) n = 25 Yes (mpap > 25 mm Hg) P < PH Progression in IPF mpap (mmhg) % Pretransplant 87% Transplant Respiration 2008;76:
7 PH in IPF: impact on 6MWT mpap <25 mm Hg (N=24) mpap > 25 mm Hg (N=10) P value 6MWD (m) 366 ± ± 66 <0.001 SpO 2 nadir (%) 88 ± 4 80 ± 4 <0.001 Lettieri et al. Chest 2006 Acute exacerbations and PH 6
8 Survival: IPAH vs PH-IIP PH IN LUNG DISEASE: PATHOGENESIS more than just the extent of parenchymal disease? 7
9 PH in IPF: No correlation with Restriction N FVC% DL CO % mpap (mmhg) Patients with PH % FVC range > 70% % % % < 40% Chest. 2007;131: Relationship between CT-fibrosis and mpap Zisman, D. A. et al. Chest 2007;132:
10 Vasculocentric Parenchymal Comorbidities Cytokines Neovascularization Fibrosis COPD Obstructive Sleep Apnea Vessel distortion Capillary Bed Destruction And Vascular Ablation Periadventitial Fibrosis Vasculopathy Shear stress Ventilation/Perfusion Mismatch Vascular capacitance Diastolic Dysfunction Acute and Chronic Pulmonary Emboli PVOD Hypoxic Vasoconstriction Coronary Artery Disease ILD ASSOCIATED PULMONARY HYPERTENSION Eur Respir Mono 2012;57:1-13. IPF Sarcoidosis COPD NSIP 9
11 PH IN ILD: When to suspect How to diagnose DIAGNOSIS PH in Lung Disease: when to suspect? History SOB that is disproportionate to the extent of ILD Physical Examination PFTs 6MWT Imaging Blood tests Loud P2 DLco < 40% Distance<200 Ratio of PA to Elevated meters aorta diameter pro ntbnp > 1 on CT of or BNP the chest Signs of right heart failure FVC%/DLCO% ratio > 1.5 Desaturation<88% on room air Pulse rate recovery < 13 beats/minute following 6MWT Echo Elevated RVSP Dilated RV/RA RV dysfunction 10
12 CT IPF 100 Percent survival PAA =< 1 PAA>1 N = 30 N = 68 p< Months Eur Respir J 2016;47:
13 Comparison of survival curves between the patients with BNP ratio 1 and BNP ratio < 1. Percent survival BNP ratio >1 BNP ratio < Time (months) N=131 Song et al. Respir Med : Echocardiography Does Not Accurately Predict PH in Patients With Idiopathic Pulmonary Fibrosis % 40% Patients (%) % Over Estimation Under Estimation Accurate N = 110, idiopathic pulmonary fibrosis patients with both echo and RHC. Comparison of RVSP by echo to PASP by RHC Nathan SD, et al. Respir Med. 2008;102:
14 Performance characteristics of RVSP thresholds for Pulmonary Hypertension (N=60) RVSP (mmhg) Sensitivity Specificity Positive Predictive Value Negative Predictive Value RVSP > RVSP > RVSP > RVSP > RVSP > RVSP > RVSP > Respir Med 2008;102: Performance characteristics of PFTs and six minute walk data alone and in combination with the RVSP for the detection of pulmonary hypertension. DLCO% Spo2 rest RVSP Excluded* RVSP (mmhg) >30 >40 >50 >60 < / / / / / 98.0 < / / / / / 97.6 < / / / / / 97.4 < / / / / / 100 < / / / / / 100 SpO2 < / / / / / 97.6 exercise < / / / / / 100 6MW Sensi 50 speci 68 < / / / / / 98.0 Distance < / / / / / 97.9 (meters) < / / / / / 97.9 *sensitivity/specificity Respir Med 2008;102:
15 What we know PH commonly complicates the course of DPLD PH associated with - worsened survival - reduced functional status -? AE s What we think we know The etiology How to diagnose PH What we don t know Is PH the driver of outcomes or a surrogate of other badness? What is disproportionate PH? Is PH adaptive or maladaptive? What we don t know, but shouldn t be too scared to ask Should we treat PH? Does it affect functional status? Survival? More harm than good? PH IN ILD: TREATMENT 14
16 Drug approvals for PAH IV Epoprostenol Bosentan 2002 SQ Treprostinil 2004 Inhaled Iloprost & IV Treprostinil 2005 Sildenafil 2006 Ambrisentan 2009 Tadalafil & Inhaled Treprostinil 2013 Riociguat &Macitentan 2014 Oral Trep Selexipag 2016 Lung Disease Investigator Year Study Design Subject Number Therapy Results Comments ILD Olschewski 1999 Open label 8 Nitric oxide, Epo IV and inhaled Inhaled prostanoids improved gas exchange ILD Ghofrani 2002 Open label 16 Sildenafil or Epo Sildenafil V/Q matching and oxygena on Prostacyclin worsened V/Q matching IPF Krowka 2007 RCT 51 Inhaled Iloprost IPF Gunther 2007 Open label 12 Bosentan IPF Collard 2007 Open label 14 Sildenafil no differences 6MWT, NYHA class, Dyspnea score, exercise O 2 sat No worsening of gas exchange 57% improved 6MWT by 20% Median follow up of 91 days ILD Minai 2008 Retrospective 19 Epo(n=10) Bosentan(n=9) 79% with 6MWT > 50 m ILD Chapman 2009 Retrospective 5 Sildenafil Improved 6MWT Decreased mpap 2 12 months IPF Zisman 2010 RCT 180 Sildenafil Failed to improve 6MWT by 20% Improved oxygen saturation and QOL 15
17 Lung Disease Investigator Year Study Design Subject Number Therapy Results Comments IPF Jackson 2010 RCT 29 Sildenafil ILD Corte 2010 Retrospective 15 Sildenafil No difference in 6MWT or Borg score Improved 6MWT and lower BNP ILD Badesch 2011 Open label 21 Ambrisentan 6MWT distance ; BNP Studied mixed PH population IPF Raghu 2013 RCT 492 Ambrisentan ILD Hoeper 2013 Open label 22 Riociguat Terminated early: lack of efficacy in time to clinical worsening Improved CO and PVR but not mpap 32 patients with PH: no change in time to disease progression O2 sat, mixed venous ILD Zimmerman 2014 Open label, observational 10 Sildenafil(n=5) Tadalafil(n=5) CO and PVR No change in 6MWT or BNP ILD Corte 2014 RCT 60 Bosentan ILD Saggar 2014 Open label 15 Treprostinil ILD Brewis 2015 Retrospective 118 PDE5 inhibs IIP Nathan 2016 RCT 143 Riociguat Unchanged:hemo s, symptoms,fc Improved hemo s without hypoxemia Improved BNP, unchanged 6MWT Terminated early: AE s & mortality RHC confirmed PH All had mpap 35 mmhg WTF! IPF prognosis can it be altered by targeting prognostic indicators? mpap 25 mm Hg mpap > 25 mm Hg P < Years 7 Lettieri CJ, et al. Chest. 2006;129: Zisman, et al. Chest 2009;135:
18 PH in Pulmonary Fibrosis: the low hanging fruit Treat the underlying condition Co-morbidities Diastolic heart failure IPF 10-18% Sarcoidosis 19% Hypoxia/nocturnal desaturation OSA PE Caveats to empiric therapy Worsening oxygenation PVOD IPF Sarcoidosis Drug/Radiation-induced fibrosis Scleroderma Occult heart failure 17
19 Step Study:? Proof of concept STEP IPF Advanced IPF (Dlco<35%) 6MWT 10%+ Sildenafil 20 mg tid Placebo 12 7%+ weeks Two-arm phase 6MWT Open-label phase Sildenafil 20 mg tid 6MWT 12 weeks The Idiopathic Pulmonary Fibrosis Clinical Research Network. N Engl J Med 2010; 363:
20 PH-ILD phase IIa study Multicenter, open label, uncontrolled study n=22 12 weeks plus 12-month extension Primary endpoint: safety and tolerability Secondary endpoints included hemodynamic changes and 6MWD Key findings Safety (n=22) AEs: dyspnea, peripheral edema (27%), dyspepsia, headache, feeling hot (14%), hypotension (9%) SAEs (possibly drug related): syncope, respiratory disorder, respiratory failure (n=1), pancytopenia (n=2), dyspnea (n=3) Efficacy 1. 6MWD, +25 m 2. Hemodynamics Cardiac index: +0.7 L/min -1. m -2 (+25%) PVR: -120 dyn s. cm -5 (-19%) PAP: no change (+1 mmhg) The results of this pilot trial indicate that riociguat appears to be well tolerated by the majority of patients with PH-ILD. It is associated with a substantial increase in cardiac output and reductions in SVR and PVR and may have the potential to improve exercise capacity in some patients 19
21 =improved by>57 m +=improved by>17 m =declined by 10 m Corte T, et al. Am J Respir Crit Care Med. 2014;190:
22 BPHIT Study: No Efficacy Signal Corte T, et al. Am J Respir Crit Care Med. 2014;190: IIP-PH: Spectrum of PH targeted therapies (COMPERA registry, n=151) Meds Baseline 1 Year ERA monotherapy 7.3% 4.7% PDE-5 inhibitor monotherapy Prostacyclin analogue 88.1% % ERA+PDE5 2.6% 2.3% Other dual therapy 2% 0% No therapy 4.7% Hoeper et al. PLOS ONE DOI: /journal.pone December 2,
23 Change in 6MWT distance: IIP-PH vs ipah (COMPERA registry, n=151 vs 798) Change in 6WMT IPAH PH-IIP >20 meters % >30 meters 53.8% 45.8% >40 meters 45.9% >50 meters 36.4% 31.3% Any worsening 26.3% 29.2% No (0-19m) 14.2% 16.6% Hoeper et al. PLOS ONE DOI: /journal.pone December 2, 2015 PH-IIP: Survival based on clinical response to PAH med (6MWT or NYHA functional class) No. patients at risk Hoeper et al. PLOS ONE DOI: /journal.pone December 2,
24 Study Design: Many Moving Parts To Get it Right! A drug that works and is well tolerated The right dose, frequency and route of administration The right patient population Disease stage, phenotype The right duration that is likely to be retained the right endpoint(s) Important inclusionary criteria: Choosing the best patient phenotype Likely to respond to therapy How to define this? Balance of amount of parenchymal lung disease versus severity of pulmonary vascular disease Casting a wide enough net Distinct entity vs distinct group of entities 23
25 Prevalence of disease:pah Data from Nathan s head Prevalence of disease:ild 24
26 Pulmonary fibrosis: a final common path? Unclassifiable ILD Am J Respir Crit Care Med 2003;168: Eur Respir J 2013;42: ILD primary determinant of outcomes PH primary determinant of outcomes Decreasing: -FVC% -Dlco% -6MWD Inflection point Vascular ablation & vasculopathy A Increasing: -mpap, -PVR Decreasing: RV function Time 25
27 IPF: Which patient group should be targeted? 70 N=178, PH in 32% 60 mpap (mmhg) FVC% Choosing the best endpoint: what does PH effect? Survival Functional status 6MWT Functional class QOL PROs AE s Hospitalization Transplantation 26
28 RIOCIGUAT PHASE 2 STUDIES: RISE-IIP RISE-IIP Study Diagnosed with a major idiopathic interstitial pneumonias Major Inclusion criteria FVC 45% 6MWD 150 m and 450 m PH confirmed by RHC with mpap 25 mmhg and PCWP 15 mmhg at rest Systolic blood pressure 95 mmhg and no signs or symptoms of hypotension WHO functional class II-IV disease Major Exclusion criteria Known significant left heart disease: Symptomatic coronary artery disease or LVEF <45% Active state of hemoptysis or pulmonary hemorrhage Difference >15% between the eligibility and the baseline 6MWD FEV 1 /FVC <0.65 after bronchodilator administration Approved IPF drug initiated within 3 months prior to screening RIOCIGUAT PHASE 2 STUDIES: RISE-IIP Efficacy endpoints Primary efficacy variables Mean change in 6MWD from baseline to week 26 Secondary efficacy variables Time to clinical worsening as evidenced by the first of any of the following four events All-cause mortality Need for hospitalization due to worsening cardiopulmonary status, attributable to progression of disease (including but not limited to increased shortness of breath or increased leg swelling) 15% decrease in 6MWD from baseline Worsening of WHO functional class 27
29 RISE-IIP, 13605: participating countries and # sites Germany / 7 France / 4 Switzerland/ 3 United Kingdom / 4 Canada / 4 USA / 12 Belgium / 1 Turkey/ 1 Japan / 5 Italy / 4 Spain / 3 Portugal / 3 New Zealand / 2 Australia / 7 14 Countries /60 Sites Portugal and Turkey added Dec 2014 New Zealand added Jan 2015 ATS
30 ATS 2016 ATS
31 ATS 2016 ATS
32 ATS 2016 DMC Teleconference with Sponsor and PI 5/5/2016 Recommended that the study be halted for increased harm to treatment arm! 31
33 Are there patients who can or should be considered for off-label PAH therapy? Unable to endorse Caveat: there are patients with hemodynamics=pah. -?group 1 PAH with comorbid DPLD The option to treat such cases can be difficult to ignore in the clinical trenches, even with a lack of supportive RCT evidence. Is this where clinical judgment and the art of medicine trump the paradigm of only practicing within the constraints of evidence-based medicine? If treatment is to be considered Pulmonary Hypertension Centers with expertise in this area, First priority populate any available clinical trials. LESSONS FROM RISE-IIP More questions than answers Should we treat complicating PH? Adaptive vs. maladaptive Compound-specific vs. concept-specific Why were these patients apparently harmed? What of V/Q mismatch What of hypotension? What of other drug AE s? Should we study IIP/ILD together? Should we do more studies? 32
34 Taking Solace from the Sages The great tragedy of science- the slaying of a beautiful hypothesis by an ugly fact T.H Buxley We hate the very idea that our own ideas may be mistaken, so we cling dogmatically to our conjectures Karl Popper Some problems are so complex that you have to be highly intelligent and well informed just to be undecided about them Laurence Peter QUESTION 1 The prevalence of PH complicating ILD is in the approximate range of: a. 5-10% b.10-35% c % d.10-85% 33
35 QUESTION 1 The prevalence of PH complicating ILD is in the approximate range of: a. 5-10% b % c % d % 6% 38% 31% 25% a. b. c. d. QUESTION 2 PH complicating ILD is associated with all of the following except: a. Shorter six minute walk distances b. Less desaturation c. Acute exacerbations of disease d. Higher mortality 34
36 QUESTION 2 PH complicating ILD is associated with all of the following except: a. Shorter six minute walk distances b. Less desaturation c. Acute exacerbations of disease d. Higher mortality 63% 31% 0% 6% a. b. c. d. QUESTION 3 PH complicating ILD should only be treated: a. When the mean pulmonary artery pressure (mpap) is >25mmHg b. When the mpap>35 mmhg c. When PH is accompanied by evidence of cor pumonale d. At an expert center 35
37 QUESTION 3 PH complicating ILD should only be treated: a. When the mean pulmonary artery pressure (mpap) is >25mmHg b. When the mpap>35 mmhg c. When PH is accompanied by evidence of cor pumonale d. At an expert center 9% 0% 0% 91% a. b. c. d. QUESTION 3 There is a strong correlation between PH in ILD and: a. The degree of restrictive physiology b. The fibrosis score on CT imaging c. The presence of underlying comorbidities d. None of the above 36
38 QUESTION 3 There is a strong correlation between PH in ILD and: a. The degree of restrictive physiology b. The fibrosis score on CT imaging c. The presence of underlying comorbidities d. None of the above 3% 5% 14% 78% a. b. c. d. 37
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
More information22nd 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
More informationOut of proportion pulmonary hypertension
IPF the missing link Out of proportion pulmonary hypertension Rome 29-30 May 2015 Sergio Harari U.O. di Pneumologia e UTIR Servizio di Emodinamica e Fisiopatologia Respiratoria Ospedale San Giuseppe -
More informationPulmonary 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
More informationPulmonary Hypertension in Chronic Obstructive Pulmonary Disease
Pulmonary Hypertension in Chronic Obstructive Pulmonary Disease Deedre Boekweg RN, BSN, CCRP Intermountain Medical Center Murray, UT Kerri Akaya Smith, MD University of Pennsylvania Philadelphia, PA PHPN
More informationEffective 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,
More informationPulmonary 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
More informationPulmonary 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
More informationPulmonary 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
More informationChronic 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
More informationManagement of Co morbidities in Idiopathic Pulmonary Fibrosis. Disclosures
Management of Co morbidities in Idiopathic Pulmonary Fibrosis Joyce S. Lee, MD MAS Director, Interstitial Lung Disease Clinic University of California, San Francisco Disclosures Intermune, advisory board
More informationPVDOMICS. Study Introduction. Kristin Highland, MD Gerald Beck, PhD. NHLBI Pulmonary Vascular Disease Phenomics Program
PVDOMICS Study Introduction Kristin Highland, MD Gerald Beck, PhD NHLBI Pulmonary Vascular Disease Phenomics Program Funded by the National Heart, Lung, and Blood Institute of the National Institutes of
More informationIdiopathic Pulmonary Fibrosis: State-of-the-Art Evaluation and Management: Comorbidities in IPF
Idiopathic Pulmonary Fibrosis: State-of-the-Art Evaluation and Management: Comorbidities in IPF Steven D. Nathan, MBBCh, FCCP Advanced Lung Disease &Transplant Program Inova Fairfax Hospital Professor
More informationPULMONARY 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
More informationReal-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
More informationPVDOMICS. Study Introduction. Kristin Highland, MD Gerald Beck, PhD. NHLBI Pulmonary Vascular Disease Phenomics Program
PVDOMICS Study Introduction Kristin Highland, MD Gerald Beck, PhD NHLBI Pulmonary Vascular Disease Phenomics Program Funded by the National Heart, Lung, and Blood Institute of the National Institutes of
More informationRole 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
More informationPulmonary 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
More informationIpertensione polmonare: cosa sta cambiando dopo Nizza 2018
Ipertensione polmonare: cosa sta cambiando dopo Nizza 2018 Sergio Harari U.O. di Pneumologia e Terapia Semi Intensiva UTIR Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Ospedale San
More informationPULMONARY 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
More informationPulmonary 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
More informationTHERAPEUTICS 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
More informationApproach to Pulmonary Hypertension in the Hospital
Approach to Pulmonary Hypertension in the Hospital Todd M Bull MD Professor of Medicine Director Pulmonary Vascular Disease Center Director Center for Lungs and Breathing Division of Pulmonary Sciences
More informationPulmonary 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
More informationThe World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.16 Subject: Letairis Page: 1 of 6 Last Review Date: June 24, 2016 Letairis Description Letairis (ambrisentan)
More informationINHALED TREPROSTINIL IN PULMONARY HYPERTENSION DUE TO INTERSTITIAL LUNG DISEASE (PH-ILD)
THE INCREASE STUDY INHALED TREPROSTINIL IN PULMONARY HYPERTENSION DUE TO INTERSTITIAL LUNG DISEASE (PH-ILD) Peter Smith, PharmD Senior Director Product Development, United Therapeutics Corporation 2 SAFE
More informationUnderstanding Complex Pulmonary Hypertension through Advanced Hemodynamics
Understanding Complex Pulmonary Hypertension through Advanced Hemodynamics Franz Rischard, DO, MS Director, Pulmonary Hypertension Program Assistant Professor of Medicine University of Arizona Lillian
More informationREVATIO (sildenafil)
RATIONALE FOR INCLUSION IN PA PROGRAM Background Pulmonary arterial hypertension is a rare disorder of the pulmonary arteries in which the pulmonary arterial pressure rises above normal levels in the absence
More informationPulmonary 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:
More informationPulmonary 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
More informationPulmonary 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
More informationPulmonary 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
More informationRecruitment and Consenting
1 Recruitment and Consenting MOP Chapter 4 NHLBI Pulmonary Vascular Disease Phenomics Program Funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health with support from
More informationADCIRCA (tadalafil) The World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)
RATIONALE FOR INCLUSION IN PA PROGRAM Background Pulmonary arterial hypertension is a rare disorder of the pulmonary arteries in which the pulmonary arterial pressure rises above normal levels in the absence
More informationThe COPD-PH Consult. When to Consider Pulmonary Vascular Disease. Diagnostic Algorithm for Pulmonary Hypertension
The COPD-PH Consult 52-year-old white male with COPD, HTN, presents with progressive DOE Current Meds: LABA/LAMA 5 years ACEI year 2 exacerbations in last year 2 LPM oxygen 6 mo An echo is ordered Function
More informationThe World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.13 Section: Prescription Drugs Effective Date: July 1 2016 Subject: Tyvaso Page: 1 of 4 Last Review
More informationTherapeutic 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
More informationThe World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.21 Subject: Orenitram Page: 1 of 6 Last Review Date: June 24, 2016 Orenitram Description Orenitram
More informationThe World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.17 Subject: Remodulin Page: 1 of 5 Last Review Date: June 24, 2016 Remodulin Description Remodulin
More informationPulmonary 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
More informationThe World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.23 Subject: Sildenafil Citrate Powder Page: 1 of 6 Last Review Date: September 15, 2017 Sildenafil
More informationPDE5 INHIBITOR POWDERS Sildenafil powder, Tadalafil powder
RATIONALE FOR INCLUSION IN PA PROGRAM Background Sildenafil and Tadalafil are marketed as Revatio and Adcirca for pulmonary arterial hypertension. This is a rare disorder of the pulmonary arteries in which
More informationPulmonary Hypertension. Murali Chakinala, M.D. Washington University School of Medicine
Pulmonary Hypertension Murali Chakinala, M.D. Washington University School of Medicine Pulmonary Circulation Alveolar Capillary relationship Pulmonary Circulation High flow, low resistance PVR ~1/15 of
More informationAnjali 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
More informationThe World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (3)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.15 Subject: Flolan Veletri Page: 1 of 5 Last Review Date: September 15, 2017 Flolan Veletri Description
More informationACTIVITY DESCRIPTION Target Audience Learning Objectives
ACTIVITY DESCRIPTION Target Audience This continuing medical education activity is planned to meet the needs of primary care physicians who can contribute to early detection of disease and who are responsible
More informationThe 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
More informationThe World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.10 Subject: Uptravi Page: 1 of 6 Last Review Date: September 15, 2017 Uptravi Description Uptravi
More informationFiltering through the Facts: Portopulmonary Hypertension Saturday, September 19, :15 10:05 a.m.
Filtering through the Facts: Portopulmonary Hypertension Saturday, September 19, 2015 9:15 10:05 a.m. Joel Wirth, MD Pulmonary & Critical Care Medicine Maine Medical Center, Portland, ME Disclosures Dr.
More informationDr. Tracy Luckhardt Division of Pulmonary, Allergy and Critical Care Medicine University of Alabama at Birmingham
Dr. Tracy Luckhardt Division of Pulmonary, Allergy and Critical Care Medicine University of Alabama at Birmingham Types of Questions you Will Be Asked Rhetorical Participatory Disclosure of Relevant Financial
More information9/15/11. Dr. Vivien Hsu Director, UMDNJ Scleroderma Program New Brunswick, NJ September Scleroderma. Hard skin
Dr. Vivien Hsu Director, UMDNJ Scleroderma Program New Brunswick, NJ September 2011 Scleroderma Hard skin 1 No diagnostic test for scleroderma Pathogenesis is unknown prominent features of disease reflect
More informationPharmacy 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
More information*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
More informationTeaching 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
More informationAcute 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,
More informationAnjali 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
More informationACTIVITY DESCRIPTION Target Audience Learning Objectives
ACTIVITY DESCRIPTION Target Audience This continuing medical education activity is planned to meet the needs of primary care providers who can contribute to early detection of disease and who are responsible
More informationΕιδικές θεραπείες σε µη-αρτηριακή πνευµονική υπέρταση, πότε; - Στέλλα Μπρίλη Α Πανεπιστηµιακή Καρδιολογική Κλινική Ιπποκράτειο Νοσοκοµείο Αθηνών
Ειδικές θεραπείες σε µη-αρτηριακή πνευµονική υπέρταση, πότε; - Στέλλα Μπρίλη Α Πανεπιστηµιακή Καρδιολογική Κλινική Ιπποκράτειο Νοσοκοµείο Αθηνών . Updated Clinical Classification of Pulmonary Hypertension
More informationELIGIBILITY 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
More informationACCP 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
More informationDisclosures. 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
More informationOral 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
More informationCome gestire le comorbidità e il follow-up
Come gestire le comorbidità e il follow-up Antonella Caminati U.O. di Pneumologia e Terapia Semi Intensiva Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Osp. San Giuseppe - MultiMedica,
More informationInstructions: This form is completed and entered for all participants. Database will skip over sections that do not apply.
Revision of 08/30/2017 Form #102 Page 1 of 6 PVDOMICS STUDY PVD Assessment - Form #102 Instructions: This form is completed and entered for all participants. Database will skip over sections that do not
More informationPaediatric 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
More informationProgress 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
More informationWhere 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
More informationThe World Health Organization (WHO) has classified pulmonary hypertension into five different groups: (2)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Tracleer Page: 1 of 6 Last Review Date: September 15, 2017 Tracleer Description Tracleer (bosentan)
More informationUpdate 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
More informationCardiac 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
More information4/14/2010. Pulmonary Hypertension: An Update. Tim Williamson, MD, FCCP. University of Kansas Hospital. Normal Physiology
Pulmonary Hypertension: An Update Tim Williamson, MD, FCCP Director, Pulmonary Vascular Program University of Kansas Hospital Normal Physiology 1 Pulmonary Perfusion 101 High Pressure Low Pressure Pulmonary
More informationPulmonary Hypertension and Left Heart Disease: What s good for the goose is not necessary good for the gander
Pulmonary Hypertension and Left Heart Disease: What s good for the goose is not necessary good for the gander Jacqueline Fearon-Clarke, MA, ACNP-BC Heart Failure and Pulmonary Hypertension Nurse Practitioner
More informationThe Circle of New Life for Pulmonary Hypertension Patients: Where does Palliative Care have a role in the new treatment era?
The Circle of New Life for Pulmonary Hypertension Patients: Where does Palliative Care have a role in the new treatment era? { Kenneth Presberg, MD Professor of Medicine Director, PHA Comprehensive Pulmonary
More informationPulmonary Arterial Hypertension (PAH): Emerging Therapeutic Strategies
Pulmonary Arterial Hypertension (PAH): Emerging Therapeutic Strategies Nick H. Kim, M.D. Clinical Professor of Medicine Director, Pulmonary Vascular Medicine Clinical Service Chief, PCCSM La Jolla Pulmonary,
More informationPulmonary vascular remodelling: causes, mechanisms and consequences
Pulmonary vascular remodelling: causes, mechanisms and consequences Ralph Schermuly Department of Pulmonary Pharmacotherapy University of Giessen and Marburg Lung Center email: ralph.schermuly@ugmlc.de
More informationChronic Pulmonary Complications HEMO 2016 Florianopolis, November 12, 2016
Chronic Pulmonary Complications HEMO 2016 Florianopolis, November 12, 2016 Samir K. Ballas, MD, FACP, FASCP, DABPM, FAAPM Emeritus Professor of Medicine and Pediatrics Cardeza Foundation for Hematologic
More informationPulmonary Hypertension: Definition and Unmet Needs
Heart Failure Center Hadassah University Hospital Pulmonary Hypertension: Definition and Unmet Needs Israel Gotsman The Heart Failure Center Hadassah University Hospital I DO NOT have a financial interest/
More informationPulmonary 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
More information2015 State-of-the-Art Management of Pulmonary Hypertension Based on an Understanding of the Various Etiologies
2015 State-of-the-Art Management of Pulmonary Hypertension Based on an Understanding of the Various Etiologies Vallerie V. McLaughlin, MD, FACC, FAHA Kim A Eagle MD Endowed Professor of Cardiovascular
More informationSA 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
More informationΠνευμονική υπέρταση: Τα 10 πιο σημαντικά κενά και παραλείψεις των Κατευθυντήριων Οδηγιών του 2015
Πνευμονική υπέρταση: Τα 10 πιο σημαντικά κενά και παραλείψεις των Κατευθυντήριων Οδηγιών του 2015 Γεωργία Γ. Πίτσιου, MD, MSc, PhD Πνευμονολόγος- Εντατικολόγος Επίκουρη Καθηγήτρια Ιατρική Σχολή ΑΠΘ Γ.Ν.
More informationADVANCED THERAPIES FOR PHARMACOLOGICAL TREATMENT OF PULMONARY HYPERTENSION
Status Active Medical and Behavioral Health Policy Section: Medicine Policy Number: II-107 Effective Date: 04/21/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members
More informationPharmacy Management Drug Policy
SUBJECT: POLICY NUMBER: PHARMACY-42 EFFECTIVE DATE: 6/2005 LAST REVIEW DATE: 4/19/2018 If the member s subscriber contract excludes coverage for a specific service or prescription drug, it is not covered
More informationRiociguat for chronic thromboembolic pulmonary hypertension
Riociguat for chronic thromboembolic pulmonary hypertension 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
More informationWhat You Need to Know About Pulmonary Arterial Hypertension: The Role of Primary Care Physicians
Saturday General Session What You Need to Know About Pulmonary Arterial Hypertension: The Role of Primary Care Physicians Trushil Shah, MD, MS Assistant Professor of Internal Medicine Pulmonary Hypertension
More informationUpdates 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
More informationΔΙΑΓΝΩΣΗ 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
More informationNeonatal and Pediatric Pulmonary Vascular Disease
Neonatal and Pediatric Pulmonary Vascular Disease Emma Olson, MS, ARNP Pediatric Cardiology Nurse Practitioner Canadian Respiratory Conference April 14, 2018 Financial Interest Disclosure (over the past
More informationPulmonary Hypertension A-Z
Pulmonary Hypertension A-Z Lana Melendres-Groves UNM Pulmonary Hypertension Program Director Assistant Professor of Medicine Pulmonary/Critical Care Division 9/17/16 Disclosures Advisory board member Actelion
More informationPulmonary hypertension. Miloslav Špaček, MD
Pulmonary hypertension Miloslav Špaček, MD Key points Pulmonary hypertension (PH) is a hemodynamic and pathophysiological abnormality found in many clinical conditions, most commonly heart and lung disease
More informationTreatment 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
More informationRecent 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
More informationIPF AND OTHER FIBROSING LUNG DISEASE: WHAT DRUGS MIGHT WORK AND ON WHOM DO THEY W ORK?
IPF AND OTHER FIBROSING LUNG DISEASE: WHAT DRUGS MIGHT WORK AND ON WHOM DO THEY W ORK? KEVIN K. BROWN, MD PROFESSOR AND VICE CHAIRMAN, DEPARTMENT OF MEDICINE NATIONAL JEWISH HEALTH DENVER, CO Kevin K.
More informationEmerging Challenges in Primary Care: Evolving Strategies of Care in Pulmonary Arterial Hypertension: Integrating the Data into Practice
Emerging Challenges in Primary Care: 2018 Evolving Strategies of Care in Pulmonary Arterial Hypertension: Integrating the Data into Practice 1 Alexander Duarte, MD Professor Division of Pulmonary Critical
More informationIV 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
More informationPULMONARY ARTERIAL HYPERTENSION AGENTS
Approvable Criteria: PULMONARY ARTERIAL HYPERTENSION AGENTS Brand Name Generic Name Length of Authorization Adcirca tadalafil Calendar Year Adempas riociguat Calendar Year Flolan epoprostenol sodium Calendar
More informationScleroderma and PAH Overview. PH Resource Network Martha Kingman, FNP C UTSW Medical Center at Dallas
Scleroderma and PAH Overview PH Resource Network 2007 Martha Kingman, FNP C UTSW Medical Center at Dallas Scleroderma and PAH Outline: Lung involvement in scleroderma Evaluation of the scleroderma patient
More informationNavigating 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
More information