Hemodynamic Targets for PH Trials.pptx

1、Mardi Gomberg-Maitland,MD,MScWalter G.Ross Professor of Clinical ResearchChief Clinical Research Officer,Office of Research Director of Pulmonary HypertensionGeorge Washington University Medicine&Health Sciences,Hemodynamic Targets for PH Therapy,Disclosures,I have the following relevant financial r

2、elationships to disclose:I am a consultant for:Acceleron/Merck,Janssen,JucaBio,Keros(ended),United TherapeuticsGW receives grant support to allow me to be a Principal Investigator from:Acceleron/Merck,Aerovate,GossamerI will discuss off label use and/or investigational use in my presentation,RHC:PH,

3、=Mean PAP 20 mm Hg at rest with PVR2 U,Hemodynamic Criteria of Pulmonary Hypertension,Kovacs et al.Eur Respir J.2024 ahead of print.,Current Target:Risk Assessment Tools:Goal Low Risk:Is this enough?,Lite 2,https:/,55mm Hg,85mm Hg,mPAP,Median Survival(mo),10mm Hg,20mm Hg,mRAP,4L/min/m2,2L/min/m2,CI,

4、DAlonzo GE et al.Ann Intern Med.1991;115:343-349.,Survival Dependent on Hemodynamics,Hemodynamic Trajectories Can Predict Outcomes,Amsallem M.Pulm Circ 2020;10(4):1-12,1997-2016Stanford 356:IPAH HPAH D-T PAH,CTD PAH306 complete RHC data197 follow-up median 2.16(1.16-3.19)yrsMPAP and MPAP/MAP ratio i

5、mproved prediction of clinical outcomes at baseline&at follow-up(mRAP,SBP,FC III/IV,CTD)Change in MPAP and MPAP/MAP did not improve prediction of clinical outcomes,STANFORD COHORT,Are we reaching our hemodynamic goals?,Vizza CD.Am J Resp Crit Care Med.2022;205(7):751-60,What is our goal?How much do

6、we improve mPAP and PVR,What is our hemodynamic target?,Vizza CD.Am J Resp Crit Care Med.2022;205(7):751-60,Improve mPAP and PVR=greater reduction of RV afterload improves RV function and clinical outcomesBased on literature+clinical experience,rigorous afterload reduction may enable significant rem