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I Thought This was a Rock Concert

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Scott Feitell, DO
Drexel College of Medicine
Philadelphia, PA, USA

When I was first assigned this Pre-Meeting Symposium 20: Pulmonary Hypertension in Left Heart Disease: WHO Group 2 PH, I thought I was going to meet Roger Daltry. Imagine my surprise to find Howard Eisen, my mentor and program chair, overseeing a session on pulmonary hypertension. Alas, instead of rocking out to links image My Generation I had to muster the energy this late in the day and on my fourth consecutive session to get excited about DPGs and PAWPs.

Dr. Nazzareno Galie started the conversation off reviewing new definitions and terminology recently decided on at a recent consensus panel. He reviewed the need to clarify terminology, and to ensure we the audience are focused solely on WHO Class 2 pulmonary hypertension due to failing of the left heart, particularly as this comprises of 80 percent of all pulmonary hypertension cases worldwide. Using new terminology, focusing on isolated post capillary pulmonary hypertension and combined post and pre-capillary hypertension, he set the groundwork for the following presenters.

Dr. Myung Park provided some of the data behind assessment of diastolic pulmonary gradients and its role in assessing pulmonary hypertension due to left heart failure. Despite the attractiveness of this concept, it seems that little data bears out its usefulness in predicting outcomes after VAD or Transplant. Perhaps when used as part of a composite assessment with other useful parameters it can still play a key role in RV and transplant studies.

Dr. James Fang furthered the discussion on pulmonary hypertension reviewing many of the benefits and limitations of current values we use every day such as PVR. He pointed out parameters such as RV stroke work index and perhaps simple measurements such as CVP that when done right and measured accurately can provide the best markers of success with VAD and transplant. He advocates for a milrinone bolus during right heart catheterization to assess RV compliance that may be better then any marker.

Finally, Dr. Robert Frantz presented some novel therapeutic options for these difficult patients as we try to get them to successful transplant or VAD placement. I think the most important take home point from his discussion was to treat the underlying problem, i.e., treat the left heart failure, diurese aggressively, and use hemodynamic monitoring to aid in treatment. Many novel therapies have been handicapped by premature study termination, or by failing to demonstrate true survival benefit, but tried and true therapies like ace inhibitors can still help these patients regardless of the pulmonary pressure.

As Roger Daltry would say, the next time I see a case of WHO Class 2 pulmonary hypertension, links image I Wont Get Fooled Again. Now time to get some dinner with My Generation.

Disclosure Statement: the author has no conflicts of interest to report.

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