With the gradual attention of the global medical field, looking back in recent years, the diagnosis and treatment methods and technological innovations for pulmonary arterial hypertension have ushered in unprecedented rapid development . The advent of PADN technology, the continuous development of large-scale clinical research, and the substantial improvement in the standardization of diagnosis and treatment have all effectively promoted the advancement of the field of pulmonary hypertension in my country. In order to strengthen international academic exchanges and cooperation in an all-round way, on May 12, 2022, the CDQI National Standardized Pulmonary Vascular Disease Center and the Left Main and Coronary Bifurcation Summit (CBS) jointly organized the American Society for Cardiovascular Angiography and Intervention (SCAI). , The “‘Lung’ is unusual, a new journey in the treatment of pulmonary arterial hypertension” academic seminar co-organized by Pamu Medical was officially held! The conference sincerely invites 12 top experts and scholars in the field of pulmonary artery from home and abroad to gather in the cloud to bring the participants a wonderful feast of academic exchanges in the field of pulmonary hypertension. Professor Raymond L. Benza, < span>Professor Ehtisham MahmudWith an in-depth analysis of the topic, with a new perspective, the fusion of Eastern and Western ideas, in order to exchange ideas between domestic and foreign experts The shared experience and cutting-edge concepts in the treatment of pulmonary arterial hypertension will jointly open a new journey in the field of pulmonary arterial hypertension treatment!
Chen Shaospan, Affiliated Nanjing Hospital of Nanjing Medical University Professor Liangwith the University of California, San DiegoProfessor Ehtisham Mahmudchaired the conference; Ohio State University span>Professor Raymond L. Benza, West China Hospital of Sichuan UniversityProfessor Chen Yucheng , The First Affiliated Hospital of Xi’an Jiaotong UniversityProfessor Fan Fenling, Beijing Anzhen Hospital Affiliated to Capital Medical University Professor Gu Hong, The First Affiliated Hospital of Zhengzhou UniversityGu Heping TeachingProfessor, Renji Hospital Affiliated to Shanghai Jiaotong University School of MedicineProfessor Shen Jieyan, Chinese People’s Liberation Army Northern Theater General HospitalProfessor Wang Qiguang, Tianjin Medical University General HospitalProfessor Yang Zhenwen< /span>, Guangdong Provincial People’s HospitalProfessor Zhang Caojinto and Nanjing Medical University Affiliated Nanjing HospitalProfessor Zhang Hang as the panelists. (in alphabetical order by last name)
Opening remarks
CDQI National Standardized Pulmonary Vascular Disease Center Pioneer College
Professor Shaoliang Chen at the beginning of the meeting,strong >First of all, in this speech, I would like to express my warm welcome and thanks to all the experts for their generous participation. At the same time, I introduced that this meeting is the fourth academic activity of the Pioneer College of the CDQI National Standardized Pulmonary Vascular Disease Center. Reflecting the close attention of Chinese physicians to the field of pulmonary arterial hypertension, this conference is honored to invite Professor Ehtisham Mahmudand Professor Raymond L. Benza participated together, hoping that the cutting-edge ideas and academic experience of international experts can rub new achievements in the field of pulmonary arterial hypertension with the participating experts.
Prof. Raymond L. Benza: Risk Stratification in Adult Patients with Pulmonary Arterial Hypertension
CDQI National Standardized Pulmonary Vascular Disease Center Pioneer College
PAH is a malignant disease characterized by elevated pulmonary arterial pressure and has a very poor prognosis. The research team has implemented 14 drug treatments since 1991, but the survival rate of patients with pulmonary arterial hypertension is still poor. Therefore, new effective drugs are developed and new treatment methods are sought to strengthen the management of adult patients with pulmonary arterial hypertension and improve risk stratification. Will help improve patient survival.Prof. Raymond L. Benzathis The second topic is around the risk management of pulmonary arterial hypertension, he mentioned that the overconfidence of clinicians will lead to wrong diagnosis results. Research shows that 64% of patients considered by clinicians as low risk, if according to the French non-invasive Sex score FPHR assessment, the assessment results are 36% of intermediate-risk patients and 28% of high-risk patients. A single test cannot provide a reliable basis for diagnosis, we need more parameters to be assessed, such as 6-minute walk distance, BNP, heart rate Functional grading, etc. The PAH assessment system applied in Europe is a multidimensional risk stratification model based on different variables, and combines the experience of clinicians to divide patients into three levels of low, medium and high risk; COMPERA 2.0 is based on this multidimensional Risk stratification model, predicted by functional classification, six-minute walk test (6MWT), and BNP or NT-proBNP, with a total of four risk stratification. The United States is assessed through the REVEAL 2.0 risk calculation table, providing three classifications or eight The risk line can better describe medium and high risks, and can predict short-term and long-term outcomes of patients, including survival rate and clinical deterioration. REVEAL Lite is relatively simplified and can help doctors make quick judgments.< /p>
In conclusion, an excellent PAH risk scoring system can be validated through retrospective studies or clinical trials, and compared with a single tool, it can provide more For comprehensive information, effective prediction of patient outcomes, help clinicians determine appropriate patient treatment strategies, and help researchers better design clinical trials. At the same time, re-evaluation can help us improve the predictive ability of risk assessment, each re-evaluation, All will help us analyze the relationship between the predicted results and the actual situation, and make the evaluation tool more effective through continuous iteration. In clinical practice, it is recommended that clinicians choose the most suitable one according to the patient’s situation In order to improve the accuracy of the assessment, the risk to the patient must not be underestimated, otherwise it will have a further serious impact on the patient.
Expert DiscussionProfessor Chen Shaoliang: The calculation of the score is critical and will have an important impact on the patient. We have tried several times in the past to explore using real world scores, and found that it often took 2 minutes to complete the risk assessment. In the just-completed PMR and FDA trials, we have also considered further optimization of the time, which can probably shorten the evaluation time to about 50 seconds, which is a big improvement.
Professor Shen Jieyan >:The promotion and use of risk scores for PAH patients in my country has been going on, and we are also thinking about how to set more reasonable formulas and parameters, and gradually improve them. The clinical manifestations of patients are different, including the degree of right heart failure, pathogenesis and application of targeted drugs, etc. The prognosis of patients is also closely related to cardiac function. Therefore, in terms of cardiac function protection, we may be able to use cardiac function parameters. Stratification, and adjust the treatment strategy according to the results of multiple stratification, so as to obtain better prognosis for patients. Professor Ehtisham Mahmud:CTEPH: Pulmonary Thromboendarterectomy and Balloon Pulmonary Artery The role of angioplasty
CDQI National Standardized Pulmonary Vascular Disease Center Pioneer College
After classifying patients with PAH by different scores and variables in risk stratification, it is possible to judge whether the patients Professor Ehtisham Mahmudthe choice of treatment for chronic thromboembolic pulmonary hypertension (CTEPH) , shared his experience with everyone.
CTEPH, as the only curable pulmonary hypertension at present, is often associated with chronic The initial diagnosis of CTEPH is difficult, and patients may be complicated with symptoms such as COPD, asthma, heart failure, unexplained shortness of breath, etc. In the diagnosis process, exclusion method is usually used to determine CTEPH, and pulmonary ventilation/perfusion shows Imaging, MRI, and right heart catheterization can also be used for diagnosis. The treatment methods of CTEPH include pulmonary thromboendarterectomy (PTE), balloon pulmonary angioplasty (BPA) and targeted drug therapy, etc., which need to be comprehensively evaluated by a multidisciplinary CTEPH team The risks and benefits of the patient’s surgical operation, and whether interventional therapy or drug therapy is needed. In the surgical therapy of CTEPH, the principles we follow include median thoracotomy, cardiopulmonary bypass, plane identification, pulmonary artery thromboendarterectomy, etc. Major surgery It generally lasts for 8-10 hours, and the patient’s postoperative hemodynamic indicators improve significantly. For a small number of patients with recurrent pulmonary hypertension, further treatment is required by BPA surgery, and we generally perform two operations within 3-7 days. At present, Surgery for PTE is still the best treatment option for suitable patients. BPA is a feasible treatment option for patients who cannot undergo surgery and patients with residual disease after PTE. Clinicians and teams need to choose BPA for treatment. Based on physiology, i.e. perfusion scan or invasive hemodynamic characteristics, determine how best to apply BPA in patients. In the future, BPA also needs to further strengthen the acquisition of data for optimal patient selection and objective adjudication, and to determine standardized technical procedures and Program end point, etc.
Expert discussionProfessor
Professor Raymond L. Benza:CTE many patients After a long-term operation, it is sometimes difficult to obtain significant curative effects, which makes both doctors and patients very frustrated. Therefore, we hope that through risk stratification, patients can be properly divided and appropriate treatment measures can be selected for them. A good prognosis can be achieved through percutaneous interventional treatment, so there is no need to undergo long surgical operations, which will effectively reduce the burden and pain of patients.
Professor Chen Shaoliang: PADN Treatment for Pulmonary Arterial Hypertension
CDQI National Standardized Pulmonary Vascular Disease Center Pioneer College
>In recent years, China’s original percutaneous pulmonary artery denervation (PADN) has attracted much attention in the field of pulmonary hypertension at home and abroad, As the developer of this technology, Professor Chen Shaolianghas rich research experience in this technology. He took this opportunity to introduce the pulmonary artery in detail. Hyperbaric PADN treatment techniques.
In all forms of PH, the occurrence of neurohormonal imbalance is closely related to the clinical prognosis and survival of PAH patients related. Excessive activation of the sympathetic nervous system (SNS) and renin-angiotensin-aldosterone system (RAAS) in patients may be the main pathway for the autonomic nervous system to participate in the mechanism of PAH, especially norepinephrine plays an important role in the formation of PAH . Therefore, helping the patient restore the balance of neurohormones will help improve the patient’s condition. In the early animal experiments, we identified for the first time that the ideal range of radiofrequency ablation was the left side of the pulmonary artery bifurcation area, and locked the best 3 ablation sites. During the 1-month follow-up, we found that the intima was healed, no thrombosis was present, and there was no nerve formation. The peripheral myelin sheath was obviously thinned or disappeared, and the feasibility and effectiveness of PADN were preliminarily confirmed. In order to further explore the safety and efficacy of PADN, the FIM study, the PADN-5 study and the PADN-CFDA study were successively carried out, and different types of patients were included. At the same time, the team found that the depth of pericardial effusion >1 cm was an independent factor for the unresponsiveness of PADN surgery. Future research on PADN therapy will continue, such as in the PADN-CFDA studyThe outcomes of patients with pulmonary hypertension associated with congenital heart disease will be further explored; the increase in 6MWD in the TRITON study was comparable to the PADN-CFDA study, but the TRITON study also showed a higher rate of clinical deterioration. Therefore, we still need more data and experimental results to verify, and it is necessary to carry out controlled trials for PADN-related combination therapy. We also expect future research results to provide more reliable evidence for the clinical application of PADN.
Expert DiscussionProf. Raymond L Benstrong: Our goal is to hopefully reduce patient mortality, so combining pulmonary artery and right ventricular function as a secondary endpoint could be of clinical importance, if supplemented in the study MRI or other relevant imaging data and using them may bring us new research ideas.
The research that combines the pulmonary artery and the right ventricle as the end point is underway. The Millar catheter was used to induce pulmonary hypertension through MCT to form an animal model. There are a total of more than 30 models, and the research also includes many This measure is expected to be completed this winter.
Professor Gu Hong: Treatment of pulmonary hypertension associated with congenital heart disease
CDQI National Standardized Pulmonary Vascular Disease Center Pioneer College
congenital heart disease The most common birth defect in my country, congenital heart disease-related pulmonary hypertension (CHD-PAH) is also the most common type of arterial pulmonary hypertension in my country. At the end of the symposium, Professor Gu Hong took CHD-PAH in my country as the starting point to share and discuss with you. CHD-PAH is mainly divided into four categories: Eisenmenger syndrome, congenital heart disease with systemic pulmonary shunt, pulmonary hypertension complicated with congenital heart disease, and congenital heart disease Postoperative pulmonary hypertension, the feasibility of surgery is mainly judged according to age and pulmonary vascular resistance, pulmonary vascular resistance and pulmonary vascular resistance/systemic resistance ratio, the higher the two, the higher the risk of postoperative residual pulmonary hypertension; for Eisenmenger comprehensive For patients with congenital heart disease with symptoms and systemic pulmonary shunt who cannot undergo surgical treatment, targeted drug therapy is recommended, such as inhaled iloprost. All in all, CHD-PAH treatment needs to consider different factors: surgical treatment should be carried out as early as possible before obstructive pulmonary vascular changes; the “treatment-repair-treatment” strategy is feasible for patients in the “gray zone” and can help. Some patients have the opportunity for surgery; PAH-targeted therapy can effectively improve the quality of life and clinical outcomes of patients. Both adults and children with CHD-PAH can be effectively treated with inhaled iloprost. Special attention should be paid to postoperative PAH. And ES patients, timely application of targeted drugs; multi-center long-term research is necessary, it will further promote the future development of CHD-PAH treatment.
Expert Discussion
Professor Gu Hong:For pediatric CHD-PAH patients, surgery is relatively more likely. Genetic screening is recommended for patients with Eisenmenger syndrome to determine whether there is a possibility of genetic mutation. Targeted drug therapy can be considered for patients in the gray area, but currently only one drug has been approved in China. For some patients with severe pulmonary hypertension, intravenous drugs may be considered for treatment.
Professor Raymond L. Benza: Patients with >Class I pulmonary hypertension need to compare their pulmonary artery pressure and shunt, and perform corresponding surgical repair according to the situation. For patients with larger shunt, the surgical effect is generally better; if the patient has a smaller shunt, it is speculated that the patient may also have some other causes, such as sympathetic nerve problems, that is, shunt is the secondary cause of pulmonary hypertension, which This condition also requires treatment with additional surgery.
/strong>As suggested by Prof. Benza, our Chinese team can develop a CHD-PAH risk assessment system based on a large number of existing research results and data, which will greatly help clinical CHD – Treatment and diagnosis of PAH.
Summary
CDQI National Standardized Pulmonary Vascular Disease Center Pioneer College
With the heated discussions of domestic and foreign academic experts, this conference officially came to an end, Professor Ehtisham MahmudandProfessor Chen Shaoliang concluded, The content of this conference covers many aspects of diagnosis and treatment in the field of pulmonary hypertension, whether it is patient risk stratification tools and clinical application methods, interventional therapy and surgical treatment of CTEPH patients, Chinese original PADN technology, or CHD-PAH patients. The contents of clinical diagnosis and treatment strategies are very substantial and meaningful. I hope that in the future, we will have the opportunity to continue to use this academic exchange platform to exchange and share experiences and experiences, so as to promote the further development of the field of pulmonary arterial hypertension!
If you need to know more about the latest treatment of pulmonary arterial hypertension-PADN technology, please contact: [email protected]
This article is the original content of “Outpatient Clinic”
Reprinted with permission and please indicate the source.
New Vision for Clinic Clinic span>｜WeChat: ClinicMZ
Long press, identify the QR code, and follow