1,721,017 research outputs found
Introduction: New insights into a challenging disease - A review of the Third World Symposium on Pulmonary Arterial Hypertension
No full textPulmonary arterial hypertension: a look to the future.
No full textThe Third World Symposium on Pulmonary Arterial Hypertension served not only as a forum for the presentation of state-of-the art overviews of the pathobiologic and clinical aspects of pulmonary arterial hypertension (PAH), but also afforded an opportunity to the international scientific community to explore future directions of research and collaboration. This summary provides a brief overview of future directions in the field
Classification of Patients with Congenital Systemic-to-Pulmonary Shunts Associated with Pulmonary Hypertension: Current Status and Future Directions
No full textLong-term outcome in pulmonary arterial hypertension patients treated with treprostinil.
No full textPulmonary arterial hypertension (PAH) is fatal if untreated. Intravenous
epoprostenol improves exercise capacity and hemodynamics in PAH, and increases
survival in idiopathic PAH (IPAH). To evaluate the effects of subcutaneous (SC)
treprostinil, a longer acting prostacyclin analogue, followed by the addition of
other PAH therapies if needed, we followed 860 PAH patients treated with SC
treprostinil for up to 4 years.Survival is reported as Kaplan-Meier estimates;
for 332 IPAH patients with baseline hemodynamics, observed survival is also
compared with predicted survival, using the NIH formula.Of the total 860
patients, 199 (23%) discontinued due to AEs, 136 (16%) died, 117 (14%)
discontinued due to deterioration, 29 (3%) withdrew consent and 11 (1%)
underwent transplantation. 97 patients (11%) switched from SC treprostinil to an
alternative prostacyclin analogue; bosentan was added in 105 patients (12%) and
sildenafil in 25 patients (3%).Survival was 87%-68% over 1-4 years for all 860
patients and 88%-70% over 1-4 years with SC treprostinil monotherapy. For the
IPAH subset with baseline hemodynamics (n=332), 91%-72% over 1-4 years; in
contrast, predicted survival was 69%-38% over 1-4 years. The safety profile for
long-term SC treprostinil was consistent with previous short-term trials with no
unexpected AEs
Treprostinil, a prostacyclin analogue, in pulmonary arterial hypertension associated with connective tissue disease.
No full textSTUDY OBJECTIVES: To assess the efficacy and safety of continuous subcutaneous infusion of treprostinil, a stable prostacyclin analogue, for treating pulmonary arterial hypertension (PAH) in patients with connective tissue disease (CTD). DESIGN: Two multicenter, randomized, double-blind, placebo-controlled, prospective trials of treprostinil vs placebo in 470 patients with PAH. PATIENTS: A subset of 90 patients with PAH and CTD, including systemic lupus erythematosus, diffuse scleroderma, limited scleroderma, and mixed CTD/overlap syndrome. INTERVENTIONS: Patients received either treprostinil (initiated at 1.25 ng/kg/min, and titrated upward) or placebo via continuous subcutaneous infusion. The maximum dose of treprostinil allowed was 22.5 ng/kg/min. MEASUREMENTS: Six-minute walk (6MW) distance and dyspnea-fatigue scores were determined at baseline, and at 6 weeks and 12 weeks. Hemodynamic measures were obtained at baseline and at 12 weeks. RESULTS: At baseline, most patients had New York Heart Association class III symptoms. The mean baseline 6MW distance was 289 m (range, 60 to 448 m). The mean dose of treprostinil at week 12 was 8.4 ng/kg/min (range, 1.25 to 17.5 ng/kg/min). After 12 weeks, the change in cardiac index from baseline was + 0.2 +/- 0.08 L/min/m(2) in the treprostinil group and - 0.07 +/- 0.07 L/min/m(2) in the placebo group (p = 0.007). The pulmonary vascular resistance index decreased by 4 +/- 2 U x m(2) in the treprostinil group and increased by 1 +/- 1 U x m(2) in the placebo group (p = 0.006). The placebo-corrected median improvement from baseline in 6MW distance was 25 m in treprostinil-treated patients (p = 0.055); this improvement appeared to be dose related. Dyspnea fatigue scores also improved in the treprostinil group compared with the placebo group (p = 0.014). Adverse events included infusion site pain and typical side effects related to prostaglandins, and were tolerated by most patients. CONCLUSIONS: Continuous subcutaneous infusion of treprostinil in patients with PAH associated with CTD improved exercise capacity, symptoms of PAH, and hemodynamics
Therapy with subcutaneous treprostinil improves survival in patients with pulmonary arterial hypertension: four-year follow-up
No full textCurrent and future management of chronic thromboembolic pulmonary hypertension:from diagnosis to treatment responses
No full textAlthough pulmonary endarterectomy (PEA) has been proven a very effective
treatment for chronic thromboembolic pulmonary hypertension, it cannot be
performed in a substantial proportion of patients. Here, we outline a proposed
treatment algorithm, outlining therapeutic alternatives: (1) PEA should be
considered as the first treatment option, where possible; (2) medical
intervention is a possible option in inoperable patients and those with
significant arteriopathy, although only chronic anticoagulation has been widely
used to date (advanced medical treatment options could include prostanoids,
endothelin receptor antagonists, or phosphodiesterase-5 inhibitors, but
randomized clinical trials are required); (3) pulmonary hypertension is likely
to persist after PEA in patients with significant small-vessel arteriopathy,
resulting in poor clinical outcome and increased perioperative mortality
(medical therapy could also be applied here); (4) anticoagulation therapy and,
possibly, advanced medical treatment with careful monitoring may provide
benefits in patients with mild or asymptomatic disease; (5) if medical therapy
begins to fail, PEA should be offered without delay to avoid progression to
severe, secondary arteriopathy; (6) in the absence of severe comorbidity, lung
transplantation may be undertaken where PEA has failed, in nonresponders to
medical therapy, and in patients with progressive arteriopathy; (7) in patients
not eligible for PEA due to collateral and/or surgically inaccessible lesions,
balloon angioplasty may be a possible alternative at some centers, but is
experimental and requires further assessment. Continued research and clinical
trials investigating possible applications of new medical treatments are
required
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
- …
