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Treat-to-target strategies in pulmonary arterial hypertension: the importance of using multiple goals

O. Sitbon, N. Galiè
European Respiratory Review 2010 19: 272-278; DOI: 10.1183/09059180.00008210
O. Sitbon
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  • For correspondence: olivier.sitbon@abc.aphp.fr
N. Galiè
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  • Figure 1.
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    Figure 1.

    Schematic diagram showing the ideal approach to pulmonary arterial hypertension management, which involves regular monitoring and early intervention.

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    Figure 2.

    Therapeutic strategy for patients with pulmonary arterial hypertension (PAH). Goal-oriented therapy algorithm. NYHA: New York Heart Association; V′O2: oxygen uptake. Reproduced from [30] with permission from the publisher.

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    Figure 3.

    Kaplan–Meier estimates of survival in 89 patients with pulmonary arterial hypertension. Survival is improved by using goal-orientated therapy. Reproduced from [30] with permission from the publisher.

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    Figure 4.

    New York Heart Association/World Health Organization functional class (FC) at follow-up strongly predicts survival. a) Epoprostenol treatment for 3 months. Reproduced from [32] with permission from the publisher. b) Epoprostenol treatment for 1 yr. Reproduced from [15] with permission from the publisher.

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  • Table 1 Goals recommended by the latest European Society of Cardiology/European Respiratory Society guidelines for pulmonary hypertension
    Better prognosisDeterminants of prognosisWorse prognosis
    NoClinical evidence of RV failureYes
    SlowRate of progression of symptomsRapid
    NoSyncopeYes
    I and IIWHO FCIV
    Longer (>500 m)#6MWTShorter (<300 m)
    Peak V′O2 >15 mL·min−1·kg−1Cardiopulmonary exercise testingPeak V′O2 <12 mL·min−1·kg−1
    Normal or near normalBNP/NT-proBNP plasma levelsVery elevated and rising
    No pericardial effusion TAPSE¶ >2.0 cmEchocardiographic findings¶Pericardial effusion TAPSE¶ <1.5 cm
    RAP <8 mmHg and CI ≥2.5 L·min−1·m−2HaemodynamicsRAP >15 mmHg or CI ≤2.0 L·min−1·m−2
    • RV: right ventricle; WHO FC: World Health Organization functional class; 6MWT: 6-min walking test; V′O2: oxygen uptake; BNP: brain natriuretic peptide; TAPSE: tricuspid annular plane systolic excursion; RAP: right arterial pressure; CI: cardiac index. #: depending on age; ¶: TAPSE and pericardial effusion have been selected as they can be measured in the majority of patients. Reproduced from [4] with permission from the publisher.

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Treat-to-target strategies in pulmonary arterial hypertension: the importance of using multiple goals
O. Sitbon, N. Galiè
European Respiratory Review Dec 2010, 19 (118) 272-278; DOI: 10.1183/09059180.00008210

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Treat-to-target strategies in pulmonary arterial hypertension: the importance of using multiple goals
O. Sitbon, N. Galiè
European Respiratory Review Dec 2010, 19 (118) 272-278; DOI: 10.1183/09059180.00008210
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  • Article
    • Abstract
    • DEFINING INADEQUATE TREATMENT RESPONSE
    • IDENTIFYING RISK FACTORS AND ESTABLISHING APPROPRIATE GOALS
    • CHALLENGES FOR THE FUTURE
    • CONCLUSION
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  • Pulmonary vascular disease
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