Early detection of pulmonary vascular disease in pulmonary arterial hypertension: time to move forward

Pulmonary arterial hypertension (PAH) can be a rapidly progressive disorder and is associated with high rate of mortality, despite medical intervention. With the availability of effective therapy, early disease detection is an important strategic objective to improve treatment outcomes. Resting echo...

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Bibliographic Details
Published in:European heart journal 2011-10, Vol.32 (20), p.2489-2498
Main Authors: Lau, Edmund M.T., Manes, Alessandra, Celermajer, David S., Galiè, Nazzareno
Format: Article
Language:English
Subjects:
Biological and medical sciences
Biomarkers - metabolism
Cardiology. Vascular system
Early Diagnosis
Echocardiography, Doppler
Exercise - physiology
Exercise Test
Familial Primary Pulmonary Hypertension
Hemodynamics - physiology
Humans
Hypertension, Pulmonary - diagnosis
Hypertension, Pulmonary - physiopathology
Magnetic Resonance Angiography
Medical sciences
Microcirculation - physiology
Patient Selection
Pneumology
Pulmonary Circulation - physiology
Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases
Respiratory Function Tests
Tomography, X-Ray Computed
Vascular Diseases - diagnosis
Vascular Diseases - physiopathology
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Summary:Pulmonary arterial hypertension (PAH) can be a rapidly progressive disorder and is associated with high rate of mortality, despite medical intervention. With the availability of effective therapy, early disease detection is an important strategic objective to improve treatment outcomes. Resting echocardiography is currently the recommended screening modality for high-risk population groups. However, it is clear that derangements in resting haemodynamics (and symptoms) are late sequelae of the pathobiological processes that begin in the distal pulmonary arteries. Exercise stress may unmask early pulmonary vascular dysfunction but the definition, clinical significance, and natural history of 'exercise PAH' remain undefined. We will review the currently available and potential future strategies aimed at early disease detection, and propose that ultimately the way forward is to detect disease at a stage prior to the rise in resting pulmonary artery pressure.
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehr160