Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna University Hospital, Bologna, Italy.
Institute of Cellular Medicine Newcastle University and The Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom.
J Am Coll Cardiol. 2013 Dec 24;62(25 Suppl):D60-72. doi: 10.1016/j.jacc.2013.10.031.
The demands on a pulmonary arterial hypertension (PAH) treatment algorithm are multiple and in some ways conflicting. The treatment algorithm usually includes different types of recommendations with varying degrees of scientific evidence. In addition, the algorithm is required to be comprehensive but not too complex, informative yet simple and straightforward. The type of information in the treatment algorithm are heterogeneous including clinical, hemodynamic, medical, interventional, pharmacological and regulatory recommendations. Stakeholders (or users) including physicians from various specialties and with variable expertise in PAH, nurses, patients and patients' associations, healthcare providers, regulatory agencies and industry are often interested in the PAH treatment algorithm for different reasons. These are the considerable challenges faced when proposing appropriate updates to the current evidence-based treatment algorithm.The current treatment algorithm may be divided into 3 main areas: 1) general measures, supportive therapy, referral strategy, acute vasoreactivity testing and chronic treatment with calcium channel blockers; 2) initial therapy with approved PAH drugs; and 3) clinical response to the initial therapy, combination therapy, balloon atrial septostomy, and lung transplantation. All three sections will be revisited highlighting information newly available in the past 5 years and proposing updates where appropriate. The European Society of Cardiology grades of recommendation and levels of evidence will be adopted to rank the proposed treatments.
肺动脉高压 (PAH) 治疗算法的要求是多方面的，在某些方面甚至相互矛盾。该治疗算法通常包括不同类型的推荐，这些推荐具有不同程度的科学证据。此外，该算法需要全面但不过于复杂，信息丰富但简单明了。治疗算法中的信息类型多种多样，包括临床、血流动力学、医学、介入、药理学和监管建议。利益相关者（或用户）包括来自不同专业的医生，他们在 PAH 方面的专业知识各不相同，护士、患者和患者协会、医疗保健提供者、监管机构和行业通常出于不同的原因对 PAH 治疗算法感兴趣。这是在提出当前基于证据的治疗算法的适当更新时面临的相当大的挑战。当前的治疗算法可分为 3 个主要领域：1）一般措施、支持性治疗、转诊策略、急性血管反应性测试和慢性钙通道阻滞剂治疗；2）批准的 PAH 药物的初始治疗；3）初始治疗的临床反应、联合治疗、球囊房间隔造口术和肺移植。所有这三个部分都将重新审视，重点介绍过去 5 年内新出现的信息，并在适当的情况下提出更新建议。欧洲心脏病学会的推荐等级和证据水平将用于对提出的治疗方法进行分级。
