CHEST Guidelines-The-Impact-of-Clinical-Treatment-Plan-of-the-New-D

The-Impact-of-Clinical-Treatment-Plan-of-the-New-D

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The correspondence highlights the implications of the new definition of precapillary pulmonary hypertension (PH) as discussed in the article by Kovacs et al. The study focused on the differences between previous and new definitions of precapillary PH and how these impact treatment plans. The authors of the letter, Zhenzhen Zheng et al., express concern over the potential need to adjust or cease targeted drug therapy for certain patients following these new definitions, noting that the full impact of stopping treatment is not well-understood. Specifically, they identify that 60% of patients with PH (group B) per the old definition would not require changes, whereas 40% might need to cease therapy. They argue that more patients are likely to discontinue treatment than those needing to initiate it under the new criteria. Concerns are raised about the insufficient sample size for groups B and C, making it challenging to draw definitive conclusions. Thus, they advocate for cautious clinical application of the new definitions and call for more extensive studies to verify the guidelines' efficacy.<br /><br />In response, Gabor Kovacs emphasizes that while the redefined criteria might lead to treatment changes, the broader advantage lies in identifying patients with early-stage pulmonary vascular disease for better follow-up and clinical trials. Kovacs supports that targeting treatment not solely based on the new definition but on hemodynamic values can advance personalized medicine, particularly in PH risk conditions like systemic sclerosis.<br /><br />The exchange underscores a debate over the clinical application of revised PH definitions with potential impacts on treatment strategies, highlighting the need for cautious implementation supported by ongoing research and data.

Keywords

precapillary pulmonary hypertension

PH definitions

treatment plans

Kovacs study

Zhenzhen Zheng

drug therapy adjustments

clinical application

personalized medicine

systemic sclerosis

clinical trials