Manzi Giovanna, Benza Raymond L, Argiento Paola, Casu Gavino, Corda Marco, Correale Michele, D'Alto Michele, Galgano Giuseppe, Garascia Andrea, Ghio Stefano, Gomberg-Maitland Mardi, Mulé Massimiliano, Paciocco Giuseppe, Papa Silvia, Prati Daniele, Preston Ioana R, Raineri Claudia, Romeo Emanuele, Scelsi Laura, Stolfo Davide, Vitulo Patrizio, White R James, Badagliacca Roberto, Vizza Carmine Dario
Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Rome, Italy.
Department of Cardiology, Mount Sinai Icahn School of Medicine, New York, NY, United States of America.
Vascul Pharmacol. 2024 Dec;157:107432. doi: 10.1016/j.vph.2024.107432. Epub 2024 Sep 10.
Despite the innovations introduced in the 2022 European Society of Cardiology/European Respiratory Society Guidelines on Pulmonary Hypertension, risk discrimination and management of pulmonary arterial hypertension (PAH) patients at intermediate risk still represents a grey zone. Additionally, clinical evidence derived from currently available studies is limited. This expert panel survey intends to aid physicians in choosing the best therapeutic strategy for patients at intermediate risk despite ongoing oral therapy. An expert panel of 24 physicians, specialized in cardiology and/or pulmonology with expertise in handling all drugs available for the treatment of PAH participated in the survey. All potential therapeutic options for patients at intermediate risk were explored and analyzed to produce graded consensus statements regarding: the switch from endothelin receptor antagonist (ERA) or phosphodiesterase 5 inhibitor (PDE5i) to another oral drug of the same class; the addition of a drug targeting the prostacyclin pathway administered by different routes; the switch from PDE5i to riociguat.
尽管2022年欧洲心脏病学会/欧洲呼吸学会肺动脉高压指南引入了创新措施，但中度风险肺动脉高压（PAH）患者的风险判别和管理仍处于灰色地带。此外，现有研究得出的临床证据有限。本次专家小组调查旨在帮助医生为正在接受口服治疗的中度风险患者选择最佳治疗策略。一个由24名心脏病学和/或肺病学专家组成的专家小组参与了此次调查，这些专家在处理所有可用于治疗PAH的药物方面具有专业知识。对中度风险患者的所有潜在治疗选择进行了探索和分析，以就以下方面产生分级共识声明：从内皮素受体拮抗剂（ERA）或磷酸二酯酶5抑制剂（PDE5i）转换为同一类别的另一种口服药物；添加通过不同途径给药的靶向前列环素途径的药物；从PDE5i转换为利奥西呱。
