An official American Thoracic Society statement: Pulmonary hypertension phenotypes

Raed A. Dweik, Sharon Rounds, Serpil C. Erzurum, Stephen Archer, Karen Fagan, Paul M. Hassoun, Nicholas S. Hill, Marc Humbert, Steven M. Kawut, Michael Krowka, Evangelos Michelakis, Nicholas W. Morrell, Kurt Stenmark, Rubin M. Tuder, John Newman, Kenneth Bloch, Benjamin Gaston

Research output: Contribution to journalArticle

48 Scopus citations

Abstract

Background: Current classification of pulmonary hypertension (PH) is based on a relatively simple combination of patient characteristics and hemodynamics. This limits customization of treatment, and lacks the clarity of a more granular identification based on individual patient phenotypes. Rapid advances in mechanistic understanding of the disease, improved imaging methods, and innovative biomarkers now provide an opportunity to define PH phenotypes on the basis of biomarkers, advancedimaging,andpathobiology. Thisdocumentorganizesour current understanding of PH phenotypes and identifies gaps in our knowledge. Methods: A multidisciplinary committee with expertise in clinical care (pulmonary, cardiology, pediatrics, and pathology), clinical research, and/or basic science in the areas of PH identified important questions and reviewed and synthesized the literature. Results: This document describes selected PH phenotypes and serves as an initial platform to define additional relevant phenotypes as new knowledge is generated. The biggest gaps in our knowledge stem from the fact that our present understanding of PH phenotypes has not come from any particularly organized effort to identify such phenotypes, but rather from reinterpreting studies and reports that were designed and performed for other purposes. Conclusions: Accurate phenotyping of PH can be used in research studies to increase the homogeneity of study cohorts. Once the ability of the phenotypes to predict outcomes has been validated, phenotyping may also be useful for determining prognosis and guiding treatment. This important next step in PH patient care can optimally be addressed through a consortium of study sites with well-defined goals, tasks, and structure. Planning and support for this could include the National Institutes of Health and the U.S. Food and Drug Administration, with industry and foundation partnerships.

Original languageEnglish (US)
Pages (from-to)345-355
Number of pages11
JournalAmerican journal of respiratory and critical care medicine
Volume189
Issue number3
DOIs
StatePublished - Feb 1 2014

Keywords

  • Biomarkers
  • Consortium
  • Metabolism
  • Pathobiology
  • Pulmonary circulation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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    Dweik, R. A., Rounds, S., Erzurum, S. C., Archer, S., Fagan, K., Hassoun, P. M., Hill, N. S., Humbert, M., Kawut, S. M., Krowka, M., Michelakis, E., Morrell, N. W., Stenmark, K., Tuder, R. M., Newman, J., Bloch, K., & Gaston, B. (2014). An official American Thoracic Society statement: Pulmonary hypertension phenotypes. American journal of respiratory and critical care medicine, 189(3), 345-355. https://doi.org/10.1164/rccm.201311-1954ST