daniel waetge ufrj hipertensão arterial pulmonar algoritmo de tratamento
TRANSCRIPT
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Daniel WaetgeUFRJ
Hipertensão Arterial PulmonarAlgoritmo de tratamento
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2013
1973 20081998 2003
Simpósios em HP
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JACC 2004
Algoritmo 2003
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Algoritmo 2008
ESC/ERJ Guidelines 2009
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Anticoagulação oral
Circulation 1984. 4 (70) 580-587
Anticoagulação
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Anticoagulação
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Anticoagulação
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Arthritis Research and Therapy 2012; 14: R213
Predictors of mortality in connective tissue disease-associated PAH: a cohort study.
warfarin
warfarin
Anticoagulação
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The Journal of Rheumatology 2012 (39) 2. 276-285
Anticoagulação
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August 27, 2009 ESC/ERS GUIDELINES
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Grupos: EXE 10 x 13 EDU24-30 sessões de 30-45 min de caminhada na esteira
Após 10 semanas
TC6M 56 ± 45 m p = 0.002
Tempo p/ intolerância ao exercício 1.9 ± 1.3 min p = 0.001
Carga de trabalho 26 ± 23 W p = 0.004
QoL SF-36v2 CAMPHOR
6/8 domínios 5/6 domínios
p < 0.05
Nenhuma melhora observada após EDU
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Ali A Weinstein et al. Respiratory Medicine 2013 (107) 778-784
Effect of aerobic exercise training on fatigue and physical activity in patients with PAH
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Ambulatory Rehabilitation Improves Exercise Capacity in Patients With Pulmonary Hypertension
Benjamin Fox et al. Journal of Cardiac Failure 2011(3)17:196-200
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EHJ Advance Access published August 27, 2009 ESC/ERS GUIDELINES
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• 1. Planejamento / Distribuição das unidades • 2. Processo de habilitação • 3. Estrutura Assistencial Especializada
• 7. Recursos Humanos• 8. Instalação e estrutura física
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Vasorreatividade nos sub-tipos de HAP
AJRCCM VOL 173 2006Humbert, Sitbon, Chaouat, et al.: Pulmonary Hypertension in France
Humbert, et al. AJRCCM 2006 (173)
Teste Agudo de Vasorreatividade
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Terapia Combinada
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Terapia Combinada (B)
Estudo Terapia em uso
Terapia acrescentada
Pacientes (n)
Duração do estudo
Endpoint primário
BREATHE-2 Bosent -Epoprost 32 16 sem RVPSTEP Bosentan Iloprost 67 12 sem TC6MPACES Epoprostenol Sildenafil 264 16 sem TC6MCOMPASS-1 Bosentan Sildenafil 45 1 dia RVPEARLY Sildenafil Bosentan 28 26 sem RVP e TC6MPHIRST Bosentan Tadalafil 400 16 sem TC6MTRIUMPH-1 Bosent ou Sildfl Treprostinil inalado 200 12 sem TC6MFREEDOM-C Bosent ou Sildfl Treprostinil VO 300 16 sem TC6MCOMPASS-2 Bosent ou Sildfl Sildenafil 250 Evento final Piora clínica
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Terapia Combinada (A)
Estudo Classe Droga Outra terapia (n) Pcnts Duração Desfechos
SERAPHIN ERA MACITENTAN IPD-5Prostaciclinas (VO, SC, Inal)
742 3 anos Morbidade Mortalidade
PATENT sGC(Ox N) RIOCIGUAT
ERAProstaciclinas (VO, SC, Inal)
363 2 anos TC6MCF
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Stümper et al. Heart 2003;89:1227-1230.
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Grupo UNIFESP
Septostomia atrial
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19901991
19921993
19941995
19961997
19981999
20002001
20022003
20042005
20062007
20082009
20100
250
500
750
1,000
1,250
1,500
1,750
2,000
2,250
2,500
2,750CF IPF COPD Alpha-1 IPAH Re-Tx
Transplant Year
Num
ber o
f Tra
nspl
ants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSMajor Indications By Year (n)
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19901991
19921993
19941995
19961997
19981999
20002001
20022003
20042005
20062007
20082009
20100
20
40
60
80
100 CF IPF COPD Alpha-1 IPAH Re-Tx
Transplant Year
% o
f Tra
nspl
ants
ISHLT 2012J Heart Lung Transplant. 2012 Oct; 31(10): 1045-1095
ADULT LUNG TRANSPLANTSMajor Indications By Year (%)
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Resumo
• Anticoagulação
• Reabilitação física
• Centros de Referências
• Teste de vasorreatividade
• Terapia Combinada
• Septostomia - Tx de Pulmão
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