A Definitive Guide to
New Applications in Diagnosis
In September, 2007 the 3rd Pulmonary Hypertension (PH) Resource
Network Symposium held in Crystal City, Virginia was a fantastic success,
with a huge (>350) attendance of health professionals including
nurses, nurse practitioners, and respiratory therapists convening to
teach, learn and network with other allied health professionals. This
year, Pulmonary Hypertension Resource Network hopes to outdo it self
again. The program, titled “Leading Progress, Creating Partnerships:
Empowering the Interdisciplinary PH Team” will again be held in
Crystal City, VA, September 24-26, 2009.
In addition to the PH Resource Network symposium, several additional PHA programs
have been in development this past year, all focused on improving education for PH
practitioners and patients. These programs have been enabled by the recently created PHA
Medical Education Fund, with $2 million in unrestricted educational industry grants, and
include the PH Preceptorship program, PHA Online University, and the 30 City Program
and PHA on the Road Educational programs for PH patients. Undeniably, this “explosion”
of PH programs in medical education reflects the rapidly growing interest in this field and
speaks to the overwhelming success of PHA in its mission to find ways to prevent and cure
PH, and to provide hope for the PH community through support, education, advocacy, and
awareness.
In addition to these medical education programs, we have seen rapid advances in
therapies for PAH which have enabled practitioners to choose from several targeted therapies
for their patients. During this time, we have also gained a better understanding and
appreciation for the multitude of diagnostic and prognostic modalities that have resulted
from improvements in biotechnology, and we can now better appreciate the physiological
aberrations caused by pulmonary vascular disease in our patients.
There are many scientists and clinicians with refined expertise in echocardiography
and in MRI as well as in invasive hemodynamics and exercise physiology, not to mention
those who avidly study a host of clinically relevant biomarkers. Each expert can readily demonstrate the many attributes that their specialized modality offers,
and can provide a unique clinicopathologic perspective on pulmonary
vascular disease.
Dr Francisco Soto served as the Guest Editor for this issue,
which focuses on several diagnostic modalities used to study PAH
patients, and provides a view from the experts that have studied
these modalities in great detail. From this information, it is clear
that several markers of PAH severity can be considered valuable
tools that enhance our understanding of PAH pathophysiology, but
no single test can be accepted as a gold standard. Indeed, as
evidenced by the Expert Roundtable in this issue, some of the issues
surrounding the utility and performance of these tests have
been somewhat controversial.
It is my hope that the contents of this issue will not only help
your understanding of the diagnostic challenges facing PAH clinicians,
but also stimulate new growth in this field and catalyze
additional research initiatives to further our knowledge base in
pulmonary vascular disease.
Ronald J. Oudiz, MD
Editor-in-Chief
Guest Editor’s Commentary
This issue of the journal focuses on current diagnostic modalities used
to diagnose and manage patients with pulmonary hypertension (PH)
and especially the more complex and severe form, pulmonary arterial
hypertension (PAH). Thanks to the impressive evolution of this field in
recent years, physicians who take care of patients with PH are being
faced with a very diverse population in whom PH etiology is frequently
multifactorial. While potentially life saving, the cost and complexity of
some of the treatments available for PAH mandate that clinicians
perform a comprehensive evaluation of patients to confirm or exclude
its presence. Likewise, given the high risk for rapid deterioration—especially in patients
with PAH—we must use a variety of tests to closely monitor treatment response.
In the first half of this issue, the authors discuss new applications and selective information
obtained from the more established diagnostic tests such as echocardiography
and right heart catheterization. Potential applications of newer diagnostic tests such as
magnetic resonance of the heart and continuous hemodynamic monitoring through
implantable devices are also discussed. Some areas of this issue will also shed light on
complex case-scenarios that clinicians who treat PH currently face: exercise-induced PH
and pulmonary vascular response in patients with nonsystolic heart failure (ie, diastolic
dysfunction).
Given the amount of unanswered questions in this field and the significant complexity
of the many cases we evaluate, correctly diagnosing and managing PH has truly become
an art. The authors who participated in this issue sincerely hope that the information
contained in these pages will give the PH-treating community additional tools to establish
a more accurate diagnosis and promptly identify signs of disease progression that require
therapeutic interventions.
Francisco J. Soto, MD, MS
Guest Editor
Articles
Advances in Pulmonary Hypertension,
Winter 2008-09, Vol. 7, No. 4
Editor-in-Chief Richard Channick, MD
Professor of Clinical Medicine
Pulmonary and Critical Care Division
University of California, San Diego Medical Center
San Diego, California
Immediate Past Editor Ronald J. Oudiz, MD
Associate Professor of Medicine
The David Geffen School of Medicine at UCLA
Director, Liu Center for Pulmonary Hypertension
LA Biomedical Research Institute at Harbor-UCLA Medical Center
Editor-in-Chief Elect Erika Berman Rosenzweig, MD
Columbia University,
College of Physicians and Surgeons
Morgan Stanley Children's Hospital of New York
Associate Editors
Kristin Highland, MD
Assistant Professor of Medicine
Division of Pulmonary, Critical Care, Allergy and Sleep Medicine
Medical University Of Carolina
Francisco Soto, MD, MS
Director, Pulmonary Hypertension Program
Pulmonary and Critical Care Medicine
Medical College of Wisconsin
Todd Bull, MD
Associate Professor of Medicine
Division of Pulmonary Sciences and Critical Care Medicine
University of Colorado Health Sciences Center
Robert Schilz, DO, PhD
Medical Director of Lung
Transplantation and Pulmonary Vascular Disease
University Hospital of Cleveland
Case Western Reserve University
Cleveland, Ohio
Publisher
Pulmonary Hypertension Association
Carl Hicks, Board Chair
Rino Aldrighetti, President
Donica Merhazion, Medical Services Associate Director
Advances in Pulmonary Hypertension is circulated to
cardiologists, pulmonologists, rheumatologists and other selected
physicians by the Pulmonary Hypertension
Association
. The contents of the
articles are
independently determined ly the Editor
and the Editorial Advisory
Board.
Editorial Mission Advances in Pulmonary Hypertension is committed
to help physicians in their clinical decision
making by informing them of important
trends affecting their practice. Analyzing the
impact of new findings and covering current
information in the peer-reviewed literature,
Advances in Pulmonary Hypertension is published
four times a year. Advances in Pulmonary
Hypertension is the official journal
of the Pulmonary Hypertension Association.
Each article in this journal has been reviewed
and approved by members of the Editorial
Advisory Board.
Editorial Board
Charles Burger, MD
Medical Director, PH Clinic
Mayo Clinic
Jacksonville, FL
Karen Fagan, M.D. Chief, Division of Pulmonary and Critical Care Medicine University of South Alabama
Eli Gabbay
Lung Transplant Unit
Royal Perth Hospital
Nick Kim, M.D.
Associate Clinical Professor of Medicine
University of California San Diego
Deborah Jo Levine, M.D.
University of Texas Health Science Center at San Antonio
San Antonio, TX
Omar Minai
Dept of Pulmonary, Allergy and Critical Care Medicine
Myung Park
Associate Professor of Medicine
Division of Pulmonary Sciences and Critical Care Medicine
University of Colorado Health Sciences Center0
Fernando Torres, MD Director Pulmonary Hypertension Clinic
UTSW Medical Center Dallas
University Hospital
Glenna Traiger, RN, MSN
Pulmonary & Critical Care
Pulmonary Hypertension CNS
University of California Los Angeles
Los Angeles, CA
R. James White, MD, PhD
Assistant Professor of Medicine, Pharmacology & Physiology
University of Rochester, Division of Pulmonary and CCM
Roham Zamanian, MD
Division of Pulmonary and Critical Care Medicine
Stanford University Medical Center
The
information provided on the PHA website is provided for general information
only. It is not intended as legal, medical or other professional
advice, and should not be relied upon as a substitute for consultations
with qualified professionals who are familiar with your individual
needs.
In September, 2007 the 3rd Pulmonary Hypertension (PH) Resource
Network Symposium held in Crystal City, Virginia was a fantastic success,
with a huge (>350) attendance of health professionals including
nurses, nurse practitioners, and respiratory therapists convening to
teach, learn and network with other allied health professionals. This
year, Pulmonary Hypertension Resource Network hopes to outdo it self
again. The program, titled “Leading Progress, Creating Partnerships:
Empowering the Interdisciplinary PH Team” will again be held in
Crystal City, VA, September 24-26, 2009.
