ArticleAmerican journal of respiratory and critical care medicine2022
Aggressive Afterload Lowering to Improve the Right Ventricle: A New Target for Medical Therapy in Pulmonary Arterial Hypertension?
Article in American journal of respiratory and critical care medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 50 citations in OpenAlex.
- Metabolomics in Pulmonary Hypertension-A Useful Tool to Provide Insights into the Dark Side of a Tricky Pathology.International journal of molecular sciences · 2023Pooled it
- Pressure-Derived Right Ventricular Ejection Fraction During Initial Dual Combination Therapy in Pulmonary Arterial Hypertension.Pulmonary circulation · 2026Article
- Activation of α7nAChR prevents maladaptive right ventricular remodeling via inhibiting the recruitment of CCR2Respiratory research · 2026Article
- Advances in and Clinical Experience with Subcutaneous Infusion Pump Therapy for Pulmonary Arterial Hypertension.Advances in therapy · 2026Review
- Transitioning Between Treprostinil Formulations: Evidence and Strategies.Advances in therapy · 2026Review
- The Pathophysiology, Mechanism, Diagnosis, and Management of Pulmonary Arterial Hypertension: A Comprehensive Literature Review.US cardiology · 2026Review
- Survival and Hemodynamic Effects of Parenteral Prostanoids in High-Altitude Group 1 Pulmonary Hypertension: A Retrospective Cohort Study.Pulmonary medicine · 2026Article
- Hypoxic microenvironment and pulmonary hypertension.Respiratory research · 2025Review
- Safety and pharmacokinetics of ralinepag, a novel oral prostacyclin receptor agonist.JHLT open · 2025Article
- Incomplete reverse remodeling in pulmonary hypertension-induced right ventricular dysfunction in aged mice.Physiological reports · 2025Article
- Right heart reverse remodeling:International journal of cardiology. Congenital heart disease · 2025Article
- The right ventricle: the co-star in the complex history of heart failure.European heart journal supplements : journal of the European Society of Cardiology · 2025Article
- Clinical Characteristics and Treatment of Patients Diagnosed with Pulmonary Arterial Hypertension: A Real-World Study in the USA, Europe and Japan.Advances in therapy · 2025Article
- Congruency between clinician-assessed risk and calculated risk of 1-year mortality in patients with pulmonary arterial hypertension: A retrospective chart review.Pulmonary circulation · 2024Article
- Clinical outcomes of upfront combination therapy for portopulmonary hypertension.International journal of cardiology. Cardiovascular risk and prevention · 2024Article
- Pharmacological Gq inhibition induces strong pulmonary vasorelaxation and reverses pulmonary hypertension.EMBO molecular medicine · 2024Article
- Right ventricular strain to systolic pulmonary artery pressure ratio in response to treatment of pulmonary arterial hypertension.ERJ open research · 2024Article
- Impact of rapid sequential combination therapy on distinct haemodynamic measures in newly diagnosed pulmonary arterial hypertension.ESC heart failure · 2024Article
- Pulmonary arterial hypertension treatment: an individual participant data network meta-analysis.European heart journal · 2024Article
- Exploratory analysis of the accuracy of echocardiographic parameters for the assessment of right ventricular function and right ventricular-pulmonary artery coupling.Pulmonary circulation · 2024Article
Corrections and comments
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Authors and funding
35 authors at 20 institutions in 17 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Despite numerous therapeutic advances in pulmonary arterial hypertension, patients continue to suffer high morbidity and mortality, particularly considering a median age of 50 years. This article explores whether early, robust reduction of right ventricular afterload would facilitate substantial improvement in right ventricular function and thus whether afterload reduction should be a treatment goal for pulmonary arterial hypertension. The earliest clinical studies of prostanoid treatment in pulmonary arterial hypertension demonstrated an important link between lowering mean pulmonary arterial pressure (or pulmonary vascular resistance) and improved survival. Subsequent studies of oral monotherapy or sequential combination therapy demonstrated smaller reductions in mean pulmonary arterial pressure and pulmonary vascular resistance. More recently, retrospective reports of initial aggressive prostanoid treatment or initial combination oral and parenteral therapy have shown marked afterload reduction along with significant improvements in right ventricular function. Some data suggest that reaching threshold levels for pressure or resistance (components of right ventricular afterload) may be key to interrupting the self-perpetuating injury of pulmonary vascular disease in pulmonary arterial hypertension and could translate into improved long-term clinical outcomes. Based on these clues, the authors postulate that improved clinical outcomes might be achieved by targeting significant afterload reduction with initial oral combination therapy and early parenteral prostanoids.
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Registered trials
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