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IS IT A HORSE OR A ZEBRA?
PULMONARY HYPERTENSION COUNCIL YEAR-IN-REVIEW

Veronica Franco, MD
PH Council Communications Liaison

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veronica francoIn medical school we were taught: "When you hear hoof beats, think horses, not zebras." So we focus on the most likely possibilities when making a diagnosis, not the unusual ones. But sometimes, physicians need to look for a zebra. In the cardiothoracic community, the zebra can be pulmonary arterial hypertension.

The Pulmonary Hypertension (PH) Council was created 5 years ago by a group of physicians interested in this rare disease. Today, our council has grown-up. Our clinical and research interests have expanded and include all different etiologies for PH. The right ventricle (RV) has taken center stage in our symposium planning committee. No longer considered a mere bystander in the cardiovascular system, RV function is recognized as an important contributor and prognostic indicator in cardiopulmonary diseases as well as post transplantation.

RV research is burgeoning, representing—along with PH—a major theme of the 2012 ISHLT Scientific Sessions in Prague, continuing an evolving trend over recent years. We had 58 abstracts accepted for 2012 (our record high), compared to 42 in 2011 and 50 at our previous vastly successful meeting in Paris in 2009. We offered 3 Pre-meeting symposia: 1) Potpourri of Special Topics in PH; 2) The RV and Pulmonary Vascular Load in Health and Disease; and 3) Congenital Heart Disease: PH Dilemmas in Pediatrics and Adult Patients. There were also 3 Scientific Sessions Concurrent Sessions: 1) Lung Transplantation for PAH - World-wide Panel Discussion; 2) Following the RV through Thick and Thin; and 3) PH in Chronic Parenchymal Lung Disease—Does it Matter? In addition, a lunch session was offered: Optimised PAH Management: Doing the Right Thing for the Right Heart (sponsored by United Therapeutics).

For the 2013 ISHLT Scientific Sessions in Montreal, we will focus our educational efforts in cross-council collaborative sessions. We will also promote broader attendance and participation of the PH community, including non-transplant and international PH specialists, as well as trainees. The ISHLT, unlikely other societies, offers a distinctive opportunity for all of us as cardiologists, pulmonologists and surgeons, to come together and challenge each other with new ideas and projects. This is undoubtedly important in the field of PH, a common disease pathway for patients with end-staged heart and lung disease. We will continue to spread PH-related topics throughout the meeting and submit a proposal for a Plenary Session. Right ventricular (dys)function, its imaging, its assessment, and its management, will remain in the spotlight.

This year, we welcome Dr. Robert Frantz as our new Chair and Dr. Mardi Gomberg-Maitland as Vice-Chair. They will carry on the tradition set by Dr. Myung Park (past-Chair) and Dr. Raymond Benza (board of directors liaison) in developing and strengthening our group. The council continues to expand both in our membership numbers as well as in the multitude of ongoing and new projects in which we are dedicated. In addition, we are pleased to welcome Dr. James West as our basic science and transitional research liaison. Dr. West's research focuses on early molecular events in the etiology of heritable pulmonary arterial hypertension, and whether these events are applicable to the broader field of idiopathic pulmonary arterial hypertension.

This year we have new committee leaders, full of enthusiasm and eager to share their fresh ideas:

  1. The Registries and Databases Committee workforce led by Drs. Stephen Mathai and Ivan Robbins, with assistance of previous representatives Mardi Gomberg-Maitland and Fernando Torres, will evaluate outcome queries based on database analyses regarding PH, RV function and transplantation
  2. The Education Committee workforce led by Dr. Dana McGlothlin, who was re-elected for her second term, will have the important task to develop the Masters Academy for 2014 in San Diego: Core competencies in Pulmonary Hypertension
  3. The Standards and Guidelines Committee workforce led by Dr. Teresa De Marco is developing several projects: guidelines regarding management of RV failure in patients with PH; perioperative management of PAH patients during non-cardiac surgery; and a consensus on hemodynamic criteria and nomenclature for PH in left-sided heart disease.
  4. The Development Committee workforce led by Dr. Evelyn Host will maintain current industry support (Gold Partner: United Therapeutics; Silver Partners: Actelion, Gilead; Corporate Partner: Bayer) as well as cultivate new sources of support.
  5. The I2C2 Committee workforce will be led by Dr. John Granton.

Our ultimate goal is to cure PH. With your help and ideas, one day we will do that. For now, we want to raise awareness so every physician will have appropriate knowledge of new developments in the field of PH and RV failure. Stay tuned!


Disclosure Statement: The author has received research support from Actelion and United Therapeutics and consultant and speaker bureau for Gilead.