Pulmonary Arterial Hypertension: Diagnosis and Evidence-Based Treatment

Pulmonary Arterial Hypertension......Page 2
Contents......Page 8
Preface......Page 12
Contributors......Page 14
1 Introduction......Page 18
2.1 Hemodynamics of pulmonary hypertension......Page 24
2.2 Venice classification......Page 25
2.3 Overview of the diagnostic process (algorithm)......Page 27
2.4 Screening (identifying a pre-existing risk)......Page 28
2.5 Detection (discovering pulmonary hypertension)......Page 30
2.7 Prediction (estimating prognosis)......Page 31
2.8 Principles of follow-up (evaluating and responding to outcome)......Page 33
2.9 Specific tests in the evaluation of pulmonary hypertension......Page 37
3 Conventional therapy in pulmonary arterial hypertension......Page 64
3.1 Calcium channel antagonists......Page 65
3.3 Warfarin......Page 69
3.4 Supplemental oxygen......Page 71
3.5 Inotropic therapy......Page 72
3.6 General measures......Page 73
3.7 Conclusions......Page 74
4 Prostanoid treatment for pulmonary arterial hypertension......Page 78
4.1 Epoprostenol......Page 80
4.2 Treprostinil......Page 94
4.3 Iloprost......Page 97
4.4 Beraprost......Page 98
4.5 Treatment selection......Page 99
4.6 Conclusions......Page 100
5 Endothelin receptor antagonists in pulmonary arterial hypertension......Page 106
5.1 Bosentan......Page 109
5.2 Sitaxsentan......Page 113
5.3 Ambrisentan......Page 116
5.4 Safety and tolerability with endothelin receptor antagonists......Page 118
5.5 Conclusions......Page 119
6.1 The origins of phosphodiesterase-5 inhibitor development......Page 122
6.2 Pulmonary hypertension as a new indication for phosphodiesterase-5 inhibitor treatment......Page 125
6.3 Role of phosphodiesterase-5 in the pulmonary vasculature......Page 126
6.4 Clinical experience with sildenafil for the treatment of chronic pulmonary hypertension......Page 127
6.5 Pivotal trial and approval of sildenafil for the treatment of pulmonary arterial hypertension (SUPER-1 study)......Page 128
6.6 Other phosphodiesterase-5 inhibitors......Page 129
6.7 Combination therapy......Page 131
6.8 Potential new indications for phosphodiesterase-5 inhibitors outside pulmonary arterial hypertension......Page 133
6.9 Conclusions......Page 135
7.1 Background......Page 144
7.2 Combination therapy to date......Page 147
7.3 Conclusions......Page 159
8.1 Introduction......Page 164
8.2 Atrial septostomy......Page 165
8.3 Pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension......Page 174
8.4 Lung transplantation for pulmonary hypertension......Page 178
8.5 Conclusions......Page 189
9.1 Introduction......Page 196
9.2 Trial design......Page 197
9.3 End points in trials of therapy for pulmonary arterial hypertension......Page 202
9.4 Conclusions......Page 214
10.1 Introduction......Page 220
10.2 Randomized controlled studies......Page 224
10.3 Long-term continuation studies......Page 226
10.4 Combination studies......Page 230
10.5 Evidence-based treatment algorithm......Page 231
10.6 Conclusions......Page 233
11.1 Definition of heart failure......Page 240
11.2 Epidemiology......Page 241
11.3 Physiology......Page 242
11.4 Evaluation of diastolic heart failure: Invasive and noninvasive techniques......Page 243
11.5 Diagnosis and treatment of diastolic dysfunction......Page 246
11.6 Pulmonary hypertension and diastolic dysfunction......Page 247
11.7 Conclusions......Page 249
12 Treatment of pulmonary arterial hypertension: A look to the future......Page 254
12.1 Therapy of pulmonary arterial hypertension......Page 257
12.3 Conclusions......Page 260
Index......Page 264
Colour Plate......Page 274