Zhi-Cheng JING, M.D; FCCP. Professor of Cardiology Pulmonary Circulation Center Tongji University School of Medicine Shanghai, China Pulmonary Arterial.
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Presentation on theme: "Zhi-Cheng JING, M.D; FCCP. Professor of Cardiology Pulmonary Circulation Center Tongji University School of Medicine Shanghai, China Pulmonary Arterial."— Presentation transcript:
Zhi-Cheng JING, M.D; FCCP. Professor of Cardiology Pulmonary Circulation Center Tongji University School of Medicine Shanghai, China Pulmonary Arterial Hypertension: New insights into 2010
In 1891, the German pathologist Romberg observed that the heart of an individual, suffering from a stricture of the pulmonary arteries due to severe sclerosis, was double the size of a man´s fist. He again named this disease sclerosis of the pulmonary arteries.
原发性肺高血压 – 发病率 : 1-2/ 百万人口 – 成人女男比 1.7:1 – 平均发病年龄 36±15 岁 –1 年、 3 年和 5 年的生存 率分别为 68%, 48% 和 34% D‘ Alonzo GE, et al. Ann Intern med.1991;115:343-349 Rich S, et al. Ann Intern med. 1987;107:216-23
Long-term response with CCBs in IPAH First study to demonstrate 95% 5-year survival in a very select group of patients with IPAH who exhibited an acute vasodilator response to CCBs Rich S,et al.N Engl J Med. 1992;327:76-81.
Survival in IPAH Long-term CCB responders Rich et al. N Engl J Med 1992
Diagnostic classification of Pulmonary Hypertension (updated 4th World Symposium on PAH, Dana Point 2008)
BAS (E/B) and/or lung transplant (E/B) Inadequate clinical response Combination therapy PDE-5 I Prostanoids ERA+ (E/B) + (B) Inadequate clinical response Continue CCB Yes Vasoreactive WHO Class I-III Oral CCB (B) Sustained response (WHO I-II) WHO Class III ERA (A) or PDE-5 I (A) Inhaled iloprost (A) SC treprostinil (B) IV epoprostenol (A) IV iloprost (C) IV treprostinil (C) Beraprost (C) WHO Class IV IV epoprostenol (A) IV iloprost (C) IV treprostinil (C) Inhaled iloprost (B) SC treprostinil (B) ERA (B) PDE-5 I (B) WHO Class II ERA (A) or PDE-5 I (A) Non-vasoreactive No PAH Evidence-based Treatment Algorithm Acute vasoreactivity test (A for iPAH) (E/C for APAH) Expert referral (E/A) Supportive therapy and general measures Avoid excessive physical exertion (E/A) Birth control (E/A) Psycho-social support (E/C) Infection prevention (E/A) Oral anticoagulants (E/B) - IPAH Diuretics (E/A) Oxygen* (E/A) Digoxin (E/C) Supervised rehabilitation (E/B) *To maintain O 2 at 92%
Survival data for PAH patients in China-from 2006-2009 The data was from Shanghai Pulmonary Hospital, Tongji University --- CDHPAH --- IPAH --- CTDPAH
WHO FC ⅠⅡ WHO FC ⅢⅣ WHO FC Ⅰ and Ⅱ WHO FC Ⅲ and Ⅳ 1 year99.1%86.3% 2 year97.2%70.7% 3 year94.8%67.3% What we should do in 2010? Earlier detection should be important data of Shanghai Pulmonary hospital
Right heart remodeling and ischemia Right coronary artery flow will be decreased or stopped during the systol- period PA-RV-LV interaction NF. Voelkel, et al. Circulation, 2006; 114: 1883. HC. Champion, et al. Circulation, 2009; 120:992.
PAH is all about the RV Time PAP PVR CO Pre-symptomatic/ Compensated Symptomatic/ Decompensating Symptom Threshold RV Failure Declining/ Decompensated
Future: what we should do? To set up the truly therapy goal : pulmonary artery remodeling—occlusion---hemodynamic worse—heart remodeling—heart failure ( not only right heart failure, the wholely cardivascular system collapse ) To reverse the right heart pathological remodeling : stronger combination therapy to 1 ） control the pulmonary arerial spasm and contraction ； 2 ） stop and reverse the pulmonary vascular remodeling; 3 ） resolve the ischemia of myocardium To investigate who is the murderer to initiate the pulmonary arterial disease : not BMPRII mutation, maybe Virus infection on the pulmonary vascular bed?
Acknowledgment 1996-2008, our team only based in Beijing From April 2008, our team actived in Beijing and Shanghai From April 2008, our lab research team was founded in Shanghai