A roadmap for therapeutic discovery in pulmonary hypertension associated with left heart failure. A scientific statement of the Heart Failure Association (HFA) of the ESC and the ESC Working Group on Pulmonary Circulation & Right Ventricular Function
Por:
Ameri, P, Mercurio, V, Pollesello, P, Anker, MS, Backs, J, Bayes-Genis, A, Borlaug, BA, Burkhoff, D, Caravita, S, Chan, SY, de Man, F, Giannakoulas, G, Gonzalez, A, Guazzi, M, Hassoun, PM, Hemnes, AR, Maack, C, Madden, B, Melenovsky, V, Mueller, OJ, Papp, Z, Pullamsetti, SS, Rainer, PP, Redfield, MM, Rich, S, Schiattarella, GG, Skaara, H, Stellos, K, Tedford, RJ, Thum, T, Vachiery, JL, van der Meer, P, Van Linthout, S, Pruszczyk, P, Seferovic, P, Coats, AJS, Metra, M, Rosano, G, Rosenkranz, S and Tocchetti, CG
Publicada:
1 abr 2024
Ahead of Print:
1 abr 2024
Resumen:
Pulmonary hypertension (PH) associated with left heart failure (LHF) (PH-LHF) is one of the most common causes of PH. It directly contributes to symptoms and reduced functional capacity and negatively affects right heart function, ultimately leading to a poor prognosis. There are no specific treatments for PH-LHF, despite the high number of drugs tested so far. This scientific document addresses the main knowledge gaps in PH-LHF with emphasis on pathophysiology and clinical trials. Key identified issues include better understanding of the role of pulmonary venous versus arteriolar remodelling, multidimensional phenotyping to recognize patient subgroups positioned to respond to different therapies, and conduct of rigorous pre-clinical studies combining small and large animal models. Advancements in these areas are expected to better inform the design of clinical trials and extend treatment options beyond those effective in pulmonary arterial hypertension. Enrichment strategies, endpoint assessments, and thorough haemodynamic studies, both at rest and during exercise, are proposed to play primary roles to optimize early-stage development of candidate therapies for PH-LHF.
Filiaciones:
Ameri, P:
Univ Genoa, Dept Internal Med, Viale Benedetto XV 6, I-16132 Genoa, Italy
IRCCS Osped Policlin San Martino, Cardiac Thorac & Vasc Dept, Viale Benedetto XV 6, I-16132 Genoa, Italy
Mercurio, V:
Univ Naples Federico II, Interdept Ctr Clin & Translat Res CIRCET, Dept Translat Med Sci, Naples, Italy
Univ Naples Federico II, Interdept Hypertens Res Ctr CIRIAPA, Naples, Italy
Pollesello, P:
Orion Pharm, Content & Commun, Branded Prod, Espoo, Finland
Anker, MS:
Charite Univ Med Berlin, Berlin Inst Hlth Ctr Regenerat Therapies BCRT, German Ctr Cardiovasc Res DZHK, Partner Site Berlin,Deutsch Herzzentrum Charite,Kl, Campus CBF, D-13353 Berlin, Germany
Backs, J:
Univ Hosp Heidelberg, Univ Heidelberg, Inst Expt Cardiol, Heidelberg, Germany
DZHK German Ctr Cardiovasc Res, Partner Site Heidelberg Mannheim, Heidelberg, Germany
:
Univ Autonoma Barcelona, Hosp Univ Germans Trias i Pujol, Heart Inst, CIBERCV, Barcelona, Spain
Borlaug, BA:
Mayo Clin, Dept Cardiovasc Dis, Rochester, MN USA
Cardiovasc Res Fdn, New York, NY USA
Burkhoff, D:
Cardiovasc Res Fdn, New York, NY USA
Caravita, S:
Univ Bergamo, Dept Management Informat & Prod Engn, Dalmine, BG, Italy
Osped San Luca, Dept Cardiol, Ist Auxol Italiano IRCCS, Milan, Italy
Chan, SY:
Univ Pittsburgh, Pittsburgh Heart Lung & Blood Vasc Med Inst, Dept Med, Div Cardiol,Sch Med, Pittsburgh, PA USA
de Man, F:
Amsterdam UMC Locat Vrije Univ Amsterdam, Dept Pulm Med, PHEniX Lab, Amsterdam, Netherlands
Amsterdam Cardiovasc Sci Pulm Hypertens & Thrombos, Amsterdam, Netherlands
Giannakoulas, G:
Aristotle Univ Thessaloniki, AHEPA Univ Hosp, Dept Cardiol 1, Thessaloniki, Greece
Gonzalez, A:
Univ Navarra, Program Cardiovasc Dis, CIMA, Pamplona, Spain
IDISNA, Pamplona, Spain
CIBERCV, Madrid, Spain
Guazzi, M:
Univ Milan, Milan, Italy
San Paolo Univ Hosp, Cardiol Div, Milan, Italy
Hassoun, PM:
Johns Hopkins Univ, Dept Med, Div Pulm & Crit Care Med, Baltimore, MD USA
Hemnes, AR:
Vanderbilt Univ, Med Ctr, Div Allergy Pulm & Crit Care Med, Nashville, TN USA
Maack, C:
Comprehens Heart Failure Ctr CHFC, Wurzburg, Germany
Univ Clin Wurzburg, Med Clin 1, Wurzburg, Germany
Madden, B:
St George Hosp, London, England
Melenovsky, V:
Inst Clin & Expt Med IKEM, Dept Cardiol, Prague, Czech Republic
Mueller, OJ:
Univ Hosp Schleswig Holstein, Dept Internal Med 5, Kiel, Germany
German Ctr Cardiovasc Res DZHK, Partner Site Hamburg Kiel Lubeck, Kiel, Germany
Papp, Z:
Univ Debrecen, Fac Med, Dept Cardiol, Div Clin Physiol, Debrecen, Hungary
Pullamsetti, SS:
Justus Liebig Univ, Excellence Cluster Cardiopulm Inst CPI, Giessen, Germany
Rainer, PP:
Med Univ Graz, Div Cardiol, Graz, Austria
BioTechMed Graz, Graz, Austria
St Johann Tirol Gen Hosp, Dept Med, St Johann In Tirol, Austria
Redfield, MM:
Mayo Clin, Dept Cardiovasc Dis, Rochester, MN USA
Rich, S:
Northwestern Univ, Feinberg Sch Med, Div Cardiol, Chicago, IL USA
Schiattarella, GG:
Charite Univ Med Berlin, Max Rubner Ctr CMR, Dept Cardiol, Berlin, Germany
German Ctr Cardiovasc Res DZHK, Partner Site Berlin, Berlin, Germany
Helmholtz Assoc MDC, Max Delbruck Ctr Mol Med, Translat Approaches Heart Failure & Cardiometab Di, Berlin, Germany
Univ Naples Federico II, Dept Adv Biomed Sci, Div Cardiol, Naples, Italy
Skaara, H:
Pulm Hypertens Assoc Europe, Vienna, Austria
Stellos, K:
Heidelberg Univ, European Ctr Angioscience ECAS, Dept Cardiovasc Res, Mannheim, Germany
Deutsch Zenrumt Herz Kreislauf Forsch, German Ctr Cardiovasc Res, Heidelberg Mannheim Partner Site, DZHK, Heidelberg, Germany
Deutsch Zentrum Herz Kreislauf Forsch, German Ctr Cardiovasc Res, DZHK, Heidelberg Mannheim Partner Site, Mannheim, Germany
Univ Hosp Mannheim, Heidelberg Univ, Dept Cardiol, Mannheim, Germany
Newcastle Univ, Biosci Inst, Fac Med Sci, Vasc Biol & Med Theme, Newcastle Upon Tyne, England
Tedford, RJ:
Med Univ South Carolina, Dept Med, Div Cardiol, Charleston, SC USA
Thum, T:
Inst Mol & Translat Therapeut Strategies IMTTS, Hannover Med Sch, Hannover, Germany
Vachiery, JL:
Hop Univ Bruxelles Erasme, Dept Cardiol, Brussels, Belgium
van der Meer, P:
Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands
Van Linthout, S:
German Ctr Cardiovasc Res DZHK, Partner Site Berlin, Berlin, Germany
Univ Med, Berlin Inst Hlth BIH Charite, BIH Ctr Regenerat Therapies, Berlin, Germany
Pruszczyk, P:
Med Univ Warsaw, Dept Internal Med & Cardiol, Warsaw, Poland
Seferovic, P:
Univ Belgrade, Fac Med, Serbian Acad Sci & Arts, Med Ctr, Koste Todorovica 8, Belgrade 11000, Serbia
Coats, AJS:
Heart Res Inst, Sydney, NSW, Australia
Metra, M:
Univ Brescia, Cardiol ASST Spedali Civili, Brescia, Italy
Univ Brescia, Dept Med & Surg Specialties Radiol Sci & Publ Hlth, Brescia, Italy
Rosano, G:
IRCCS San Raffaele, Rome, Italy
Rosenkranz, S:
Univ Hosp Cologne, Dept Cardiol, Cologne, Germany
Univ Hosp Cologne, Cologne Cardiovasc Res Ctr CCRC, Heart Ctr, Cologne, Germany
Univ Cologne, Fac Med, Ctr Mol Med Cologne CMMC, Cologne, Germany
Tocchetti, CG:
Univ Naples Federico II, Interdept Ctr Clin & Translat Res CIRCET, Dept Translat Med Sci, Naples, Italy
Univ Naples Federico II, Interdept Hypertens Res Ctr CIRIAPA, Naples, Italy
Univ Naples Federico II, Ctr Basic & Clin Immunol Res CISI, Naples, Italy
Univ Naples Federico II, Ctr Basic & Clin Immunol Res CISI, Interdept Ctr Clin & Translat Res CIRCET, Interdept Hypertens Res Ctr CIRIAPA,Dept Translat, Via Sergio Pansini 5, I-80131 Naples, Italy
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