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Aggressive Afterload Lowering to Improve the Right Ventricle: A New Target for Medical Therapy in Pulmonary Arterial Hypertension?

Research output: Contribution to journalJournal articlepeer-review

Harvard

Vizza, CD, Lang, IM, Badagliacca, R, Benza, RL, Rosenkranz, S, White, RJ, Adir, Y, Andreassen, AK, Balasubramanian, V, Bartolome, S, Blanco, I, Bourge, RC, Carlsen, J, Conde Camacho, RE, D'Alto, M, Farber, HW, Frantz, RP, Ford, HJ, Ghio, S, Gomberg-Maitland, M, Naeije, R, Orfanos, SE, Oudiz, RJ, Perrone, SV, Shlobin, OA, Simon, MA, Torres, F, Wang, K-Y, Yacoub, MH, Liu, Y, Golden, G & Matsubara, H 2022, 'Aggressive Afterload Lowering to Improve the Right Ventricle: A New Target for Medical Therapy in Pulmonary Arterial Hypertension?', American Journal of Respiratory and Critical Care Medicine, vol. 205, no. 7, pp. 751-760. https://doi.org/10.1164/rccm.202109-2079PP

APA

Vizza, C. D., Lang, I. M., Badagliacca, R., Benza, R. L., Rosenkranz, S., White, R. J., Adir, Y., Andreassen, A. K., Balasubramanian, V., Bartolome, S., Blanco, I., Bourge, R. C., Carlsen, J., Conde Camacho, R. E., D'Alto, M., Farber, H. W., Frantz, R. P., Ford, H. J., Ghio, S., ... Matsubara, H. (2022). Aggressive Afterload Lowering to Improve the Right Ventricle: A New Target for Medical Therapy in Pulmonary Arterial Hypertension? American Journal of Respiratory and Critical Care Medicine, 205(7), 751-760. https://doi.org/10.1164/rccm.202109-2079PP

CBE

Vizza CD, Lang IM, Badagliacca R, Benza RL, Rosenkranz S, White RJ, Adir Y, Andreassen AK, Balasubramanian V, Bartolome S, Blanco I, Bourge RC, Carlsen J, Conde Camacho RE, D'Alto M, Farber HW, Frantz RP, Ford HJ, Ghio S, Gomberg-Maitland M, Naeije R, Orfanos SE, Oudiz RJ, Perrone SV, Shlobin OA, Simon MA, Torres F, Wang K-Y, Yacoub MH, Liu Y, Golden G, Matsubara H. 2022. Aggressive Afterload Lowering to Improve the Right Ventricle: A New Target for Medical Therapy in Pulmonary Arterial Hypertension?. American Journal of Respiratory and Critical Care Medicine. 205(7):751-760. https://doi.org/10.1164/rccm.202109-2079PP

MLA

Vancouver

Author

Vizza, Carmine Dario ; Lang, Irene M ; Badagliacca, Roberto ; Benza, Raymond L ; Rosenkranz, Stephan ; White, R James ; Adir, Yochai ; Andreassen, Arne K ; Balasubramanian, Vijay ; Bartolome, Sonja ; Blanco, Isabel ; Bourge, Robert C ; Carlsen, Jørn ; Conde Camacho, Rafael Enrique ; D'Alto, Michele ; Farber, Harrison W ; Frantz, Robert P ; Ford, H James ; Ghio, Stefano ; Gomberg-Maitland, Mardi ; Naeije, Robert ; Orfanos, Stylianos E ; Oudiz, Ronald J ; Perrone, Sergio V ; Shlobin, Oksana A ; Simon, Marc A ; Torres, Fernando ; Wang, Kuo-Yang ; Yacoub, Magdi H ; Liu, Yan ; Golden, Gil ; Matsubara, Hiromi. / Aggressive Afterload Lowering to Improve the Right Ventricle : A New Target for Medical Therapy in Pulmonary Arterial Hypertension?. In: American Journal of Respiratory and Critical Care Medicine. 2022 ; Vol. 205, No. 7. pp. 751-760.

Bibtex

@article{125f8fc81ca54f31b506910562e491bf,
title = "Aggressive Afterload Lowering to Improve the Right Ventricle: A New Target for Medical Therapy in Pulmonary Arterial Hypertension?",
abstract = "Despite numerous therapeutic advances in pulmonary arterial hypertension, patients continue to suffer high morbidity and mortality, particularly considering a median age of 50 years. This article explores whether early, robust reduction of right ventricular afterload would facilitate substantial improvement in right ventricular function and thus whether afterload reduction should be a treatment goal for pulmonary arterial hypertension. The earliest clinical studies of prostanoid treatment in pulmonary arterial hypertension demonstrated an important link between lowering mean pulmonary arterial pressure (or pulmonary vascular resistance) and improved survival. Subsequent studies of oral monotherapy or sequential combination therapy demonstrated smaller reductions in mean pulmonary arterial pressure and pulmonary vascular resistance. More recently, retrospective reports of initial aggressive prostanoid treatment or initial combination oral and parenteral therapy have shown marked afterload reduction along with significant improvements in right ventricular function. Some data suggest that reaching threshold levels for pressure or resistance (components of right ventricular afterload) may be key to interrupting the self-perpetuating injury of pulmonary vascular disease in pulmonary arterial hypertension and could translate into improved long-term clinical outcomes. Based on these clues, the authors postulate that improved clinical outcomes might be achieved by targeting significant afterload reduction with initial oral combination therapy and early parenteral prostanoids. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).",
author = "Vizza, {Carmine Dario} and Lang, {Irene M} and Roberto Badagliacca and Benza, {Raymond L} and Stephan Rosenkranz and White, {R James} and Yochai Adir and Andreassen, {Arne K} and Vijay Balasubramanian and Sonja Bartolome and Isabel Blanco and Bourge, {Robert C} and J{\o}rn Carlsen and {Conde Camacho}, {Rafael Enrique} and Michele D'Alto and Farber, {Harrison W} and Frantz, {Robert P} and Ford, {H James} and Stefano Ghio and Mardi Gomberg-Maitland and Robert Naeije and Orfanos, {Stylianos E} and Oudiz, {Ronald J} and Perrone, {Sergio V} and Shlobin, {Oksana A} and Simon, {Marc A} and Fernando Torres and Kuo-Yang Wang and Yacoub, {Magdi H} and Yan Liu and Gil Golden and Hiromi Matsubara",
year = "2022",
month = apr,
day = "1",
doi = "10.1164/rccm.202109-2079PP",
language = "English",
volume = "205",
pages = "751--760",
journal = "American Journal of Respiratory and Critical Care Medicine",
issn = "1073-449X",
publisher = "American Thoracic Society",
number = "7",

}

RIS

TY - JOUR

T1 - Aggressive Afterload Lowering to Improve the Right Ventricle

T2 - A New Target for Medical Therapy in Pulmonary Arterial Hypertension?

AU - Vizza, Carmine Dario

AU - Lang, Irene M

AU - Badagliacca, Roberto

AU - Benza, Raymond L

AU - Rosenkranz, Stephan

AU - White, R James

AU - Adir, Yochai

AU - Andreassen, Arne K

AU - Balasubramanian, Vijay

AU - Bartolome, Sonja

AU - Blanco, Isabel

AU - Bourge, Robert C

AU - Carlsen, Jørn

AU - Conde Camacho, Rafael Enrique

AU - D'Alto, Michele

AU - Farber, Harrison W

AU - Frantz, Robert P

AU - Ford, H James

AU - Ghio, Stefano

AU - Gomberg-Maitland, Mardi

AU - Naeije, Robert

AU - Orfanos, Stylianos E

AU - Oudiz, Ronald J

AU - Perrone, Sergio V

AU - Shlobin, Oksana A

AU - Simon, Marc A

AU - Torres, Fernando

AU - Wang, Kuo-Yang

AU - Yacoub, Magdi H

AU - Liu, Yan

AU - Golden, Gil

AU - Matsubara, Hiromi

PY - 2022/4/1

Y1 - 2022/4/1

N2 - Despite numerous therapeutic advances in pulmonary arterial hypertension, patients continue to suffer high morbidity and mortality, particularly considering a median age of 50 years. This article explores whether early, robust reduction of right ventricular afterload would facilitate substantial improvement in right ventricular function and thus whether afterload reduction should be a treatment goal for pulmonary arterial hypertension. The earliest clinical studies of prostanoid treatment in pulmonary arterial hypertension demonstrated an important link between lowering mean pulmonary arterial pressure (or pulmonary vascular resistance) and improved survival. Subsequent studies of oral monotherapy or sequential combination therapy demonstrated smaller reductions in mean pulmonary arterial pressure and pulmonary vascular resistance. More recently, retrospective reports of initial aggressive prostanoid treatment or initial combination oral and parenteral therapy have shown marked afterload reduction along with significant improvements in right ventricular function. Some data suggest that reaching threshold levels for pressure or resistance (components of right ventricular afterload) may be key to interrupting the self-perpetuating injury of pulmonary vascular disease in pulmonary arterial hypertension and could translate into improved long-term clinical outcomes. Based on these clues, the authors postulate that improved clinical outcomes might be achieved by targeting significant afterload reduction with initial oral combination therapy and early parenteral prostanoids. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

AB - Despite numerous therapeutic advances in pulmonary arterial hypertension, patients continue to suffer high morbidity and mortality, particularly considering a median age of 50 years. This article explores whether early, robust reduction of right ventricular afterload would facilitate substantial improvement in right ventricular function and thus whether afterload reduction should be a treatment goal for pulmonary arterial hypertension. The earliest clinical studies of prostanoid treatment in pulmonary arterial hypertension demonstrated an important link between lowering mean pulmonary arterial pressure (or pulmonary vascular resistance) and improved survival. Subsequent studies of oral monotherapy or sequential combination therapy demonstrated smaller reductions in mean pulmonary arterial pressure and pulmonary vascular resistance. More recently, retrospective reports of initial aggressive prostanoid treatment or initial combination oral and parenteral therapy have shown marked afterload reduction along with significant improvements in right ventricular function. Some data suggest that reaching threshold levels for pressure or resistance (components of right ventricular afterload) may be key to interrupting the self-perpetuating injury of pulmonary vascular disease in pulmonary arterial hypertension and could translate into improved long-term clinical outcomes. Based on these clues, the authors postulate that improved clinical outcomes might be achieved by targeting significant afterload reduction with initial oral combination therapy and early parenteral prostanoids. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

UR - http://www.scopus.com/inward/record.url?scp=85128160726&partnerID=8YFLogxK

U2 - 10.1164/rccm.202109-2079PP

DO - 10.1164/rccm.202109-2079PP

M3 - Journal article

C2 - 34905704

VL - 205

SP - 751

EP - 760

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

SN - 1073-449X

IS - 7

ER -

ID: 72185963