Valore predittivo della radiografia del torace nella diagnosi di ipertensione polmonare

Pulmonary endarterectomy (PEA) is the treatment of choice for patients with symptomatic CTEPH1. However, a substantial proportion of these patients are considered inoperable due to a distal pulmonary vascular obstruction, or to attendant hypertensive pulmonary arteriopathy1-3. Patients with Inop-CTEPH treated with conventional therapy (oxygen, anticoagulants, digitalis, diuretics and calcium-channel blockers) have a poor survival particularly those with a pulmonary artery mean pressure>30 mmHg 4,5. More recently, drugs such as prostanoids, endothelin receptor antagonists and phosphodiesterase-5 inhibitors have produced functional and even long-term (3 years) survival benefits in patients of Group 1 of the new pulmonary artery hypertension (PAH) classification. Several off-label studies with these drugs have been performed in Inop-CTEPH patients suggesting hemodynamic, clinical and survival improvement 6-10. Beneficial effects of these drugs in Inop-CTEPH patients may be further defined through randomized controlled trials The aim of this study was to present data on the 3-year survival and on the clinical and functional courses of Inop-CTEPH patients treated with conventional therapy versus those treated with conventional and combined novel drug therapy. Conclusions: Novel vasodilator drugs to treat PAH and oxygen supplementation improve hemodynamic, O2 handling and acid-base balance in patients with inoperable CTEPH, delaying progression of right heart failure and increasing 3-year survival. 1. Hoeper MM, Circulation 113:2011- 2020 2. Dartevelle P, Eur Respir J 23:637-648 3. Galie` N, Proc Am Thorac Soc 3:571-576 4. Bresser P, Proc Am Thorac Soc 3:594-600 5. Lewczuk J, Chest 119:818-823 6. Reichenberger F. Eur Respr J30:922-927 7. Condliffe R., Am J Respir Crit Care Med 177:1122-1127 8. Hughes RJ, Eur Respir J28:138-143 9. Ja?¨s X, J Am Coll Cardio l52:2127-2134 10. Seyfarth H-J, Clin Res Cardiol 99:553-556