Pulmonary Hypertension CHEST 2020, ERS 2020 CME ACCREDITED Watch Time: 55 mins

touchCONGRESS Medical therapy for CTEPH: New data new horizons

Watch this two-part activity discussing the latest developments in the use of medical therapy for the management of CTEPH. Filmed following CHEST 2020 and ERS 2020.

Part 1: Watch internationally renowned expert Prof. Joanna Pepke-Zaba review key data from the congresses Watch Now
Part 2: Choose from leading experts who discuss what the latest data mean for global and regional practice Select An Interview

  • Part 1: Data Review
Next Chapter
Introduction
Assessment of patients with CTEPH
New and emerging data on medical therapies in CTEPH
Best practice in the management of CTEPH
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Overview

Watch Prof. Joanna Pepke-Zaba reviewing the latest data from CHEST 2020 and ERS 2020 on the role of medical therapy in CTEPH, and consider:

  • How to best assess patients with CTEPH
  • What are the new and emerging data in the role of medical therapy in CTEPH?
  • What is best practice in the management of patients with CTEPH?
About Joanna Pepke-Zaba

Prof. Joanna Pepke-Zaba, PhD, FRCP, graduated from Warsaw University School of Medicine in Poland before undertaking a fellowship in respiratory physiology at Papworth and Addenbrooke’s Hospitals, University of Cambridge, UK, which resulted in a PhD. She was the lead physician and director of the National Pulmonary Vascular Diseases Unit (PVDU) at Royal Papworth Hospital from 2003 to 2019. The PVDU is one of the seven designated pulmonary hypertension centres in the UK and is a member of the European Reference Network on rare respiratory disease (ERN-LUNG), providing predominantly for patients with pulmonary hypertension (groups 1 and 4). read more

She led the National Chronic Thromboembolic Pulmonary Hypertension (CTEPH) program together with cardiothoracic surgeons (pulmonary endarterectomy[PEA]) and with interventional cardiologist (balloon pulmonary angioplasty [BPA]) services between 2003 and 2020. Royal Papworth is the sole provider of PEA and BPA in the UK. Royal Papworth is one of the three largest PEA centres in the world.

Her main research has concentrated on translational programs in the field of pulmonary hypertension with specific interest in CTEPH and pulmonary arterial hypertension. The PVDU has an active clinical trials program, participating in more than 30 randomized controlled trials over the last 12 years, and investigator-driven original research studies. The PVDU is closely collaborating with several pulmonary hypertension centres across the world.

She supervises fellows towards higher post graduate degrees: MD and PhD. She has published over 160 papers in peer-reviewed journals, book chapters in the field of pulmonary hypertension, and serves on various educational and scientific international committees. She is a founding member of the International CTEPH Association. She has been Honorary Senior Visiting Fellow, University of Cambridge and School of Clinical Medicine since 2011. As of September 2020, she has been appointed by the ERS as a Clinical Research Collaboration Working Group member.

Prof. Joanna Pepke-Zaba discloses: Personal fees from Actelion, Bayer Pharmaceuticals and Merck.

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  • Part 2: Expert Interviews
Prof. Joanna Pepke-Zaba
Watch Time: 09:32
Royal Papworth Hospital, Cambridge, UK

Prof. Joanna Pepke-Zaba discusses the current unmet needs in the management of patients with CTEPH and how new data may impact on practice.

 
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Interview Questions

In this interview, Prof. Joanna Pepke-Zaba answers the following questions:

  • Several presentations looked at pre-operative assessment of patients. In your opinion, what are the greatest challenges when performing such assessments?
  • With several presentations covering individual centre’s experience of balloon pulmonary angioplasty (BPA), how do you think we should assess patients following BPA?
  • In your opinion, what are the criteria for switching treatment in patients not meeting treatment goals?
  • Abstracts were presented investigating dual oral combination and multimodal therapies. What do you think are the potential implications of such treatment modalities for daily clinical practice?
  • In your opinion, how will the ongoing COVID-19 pandemic affect the assessment and monitoring of patients with CTEPH?
About Prof. Joanna Pepke-Zaba

Prof. Joanna Pepke-Zaba, PhD, FRCP, graduated from Warsaw University School of Medicine in Poland before undertaking a fellowship in respiratory physiology at Papworth and Addenbrooke’s Hospitals, University of Cambridge, UK, which resulted in a PhD. She was the lead physician and director of the National Pulmonary Vascular Diseases Unit (PVDU) at Royal Papworth Hospital from 2003to 2019. The PVDU is one of the seven designated pulmonary hypertension centres in the UK and is a member of the European Reference Network on rare respiratory disease (ERN-LUNG), providing predominantly for patients with pulmonary hypertension (groups 1 and 4). read more

She led the National Chronic Thromboembolic Pulmonary Hypertension (CTEPH) program together with cardiothoracic surgeons (pulmonary endarterectomy[PEA]) and with interventional cardiologist (balloon pulmonary angioplasty [BPA]) services between 2003 and 2020. Royal Papworth is the sole provider of PEA and BPA in the UK. Royal Papworth is one of the three largest PEA centres in the world.

Her main research has concentrated on translational programs in the field of pulmonary hypertension with specific interest in CTEPH and pulmonary arterial hypertension. The PVDU has an active clinical trials program, participating in more than 30 randomized controlled trials over the last 12 years, and investigator-driven original research studies. The PVDU is closely collaborating with several pulmonary hypertension centres across the world.

She supervises fellows towards higher post graduate degrees: MD and PhD. She has published over 160 papers in peer-reviewed journals, book chapters in the field of pulmonary hypertension, and serves on various educational and scientific international committees. She is a founding member of the International CTEPH Association. She has been Honorary Senior Visiting Fellow, University of Cambridge and School of Clinical Medicine since 2011. As of September 2020, she has been appointed by the ERS as a Clinical Research Collaboration Working Group member.

Prof. Joanna Pepke-Zaba discloses: Personal fees from Actelion, Bayer Pharmaceuticals and Merck.

Prof. Kim Kerr
Watch Time: 04:27
University of California, San Diego, USA

Prof. Kim Kerr discusses the current unmet needs in the management of patients with CTEPH and how new data may impact on practice.

 
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Interview Questions

In this interview, Prof. Kim Kerr answers the following questions:

  • Several presentations looked at pre-operative assessment of patients. In your opinion, what are the greatest challenges when performing such assessments?
  • With several presentations covering individual centre’s experience of balloon pulmonary angioplasty (BPA), how do you think we should assess patients following BPA?
  • In your opinion, what are the criteria for switching treatment in patients not meeting treatment goals?
  • Abstracts were presented investigating dual oral combination and multimodal therapies. What do you think are the potential implications of such treatment modalities for daily clinical practice?
  • In your opinion, how will the ongoing COVID-19 pandemic affect the assessment and monitoring of patients with CTEPH?
About Prof. Kim Kerr

Prof. Kim Kerr is Clinical Professor of Medicine and Vice Chief of the Division of Pulmonary, Critical Care, and Sleep Medicine at the University of California San Diego. Dr. Kerr attended Temple University School of Medicine and did her residency at the Medical College of Pennsylvania. This was followed by a fellowship in Pulmonary and Critical Care at the University of California, San Francisco. Dr. Kerr joined the Pulmonary Vascular Program at UCSD in 1993 as a research fellow and was appointed to the faculty in 1996. Dr. Kerr’s clinical and research interests are focused on CTEPH and she is currently Principal Investigator for the United States CTEPH Registry.

Prof. Kim Kerr discloses: Grant/research fees from Bayer Pharmaceuticals.

Prof. Hiromi Matsubara
Watch Time: 08:57
Okayama Medical Center, Okayama-shi, Japan

Prof. Hiromi Matsubara discusses the current unmet needs in the management of patients with CTEPH and how new data may impact on practice.

 
 
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Interview Questions

In this interview, Prof. Hiromi Matsubara answers the following questions:

  • Several presentations looked at pre-operative assessment of patients. In your opinion, what are the greatest challenges when performing such assessments?
  • With several presentations covering individual centre’s experience of balloon pulmonary angioplasty (BPA), how do you think we should assess patients following BPA?
  • In your opinion, what are the criteria for switching treatment in patients not meeting treatment goals?
  • Abstracts were presented investigating dual oral combination and multimodal therapies. What do you think are the potential implications of such treatment modalities for daily clinical practice?
  • In your opinion, how will the ongoing COVID-19 pandemic affect the assessment and monitoring of patients with CTEPH?
About Prof. Hiromi Matsubara

Prof. Hiromi Matsubara’s investigative interests have focused on clinical and physiological aspects of pulmonary hypertension. He has worked to improve the outcome of treatment for pulmonary arterial hypertension and started high-dose and rapid up-titration of epoprostenol combined with other oral drugs. read more

As a result, long-term survival of patients treated at Okayama Medical Center was remarkably improved. In 2004, he started balloon pulmonary angioplasty (BPA) for chronic thromboembolic pulmonary hypertension. His experience includes having conducted around 2,500 BPA procedures in more than 450 patients during the past 16 years, thereby establishing the safety and efficacy of the. He has made the Department of Cardiology at Okayama Medical Center the largest BPA center in Japan.

Prof. Hiromi Matsubara discloses: Speaker fees from Actelion, Bayer Yakuhin and Nippon Shinyaku.

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Overview & Learning Objectives
Overview

In this activity, Prof. Joanna Pepke-Zaba reviews the latest data from CHEST 2020 and ERS 2020 on the use of medical therapy in CTEPH.

This activity has been jointly provided by Oakstone and touchIME. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians. read more

Target audience

This activity has been designed to meet the educational needs of pulmonologists, cardiologists, cardiopulmonary surgeons, rheumatologists and other healthcare professionals involved in the multidisciplinary management of patients with CTEPH, globally.

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Faculty

Prof. Joanna Pepke-Zaba discloses:  Personal fees from Actelion, Bayer Pharmaceuticals and Merck.

Prof. Kim Kerr discloses:  Grant/research fees from Bayer Pharmaceuticals.

Prof. Hiromi Matsubara discloses: Speaker fees from Actelion, Bayer Yakuhin and Nippon Shinyaku.

Content Reviewer

Walter Murray Yarbrough, MD, FACP, has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Paul Taylor has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

Oakstone Publishing designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In order to receive credit for this activity, participants must review and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AME). European physicians interested in converting 0.5 AMA PRA Category 1 Credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Date of original release: 16 December 2020. Date credits expire: 16 December 2021.

Learning Objectives

After watching this activity, participants should be better able to:

  • Recall the new and emerging data around patient and disease characteristics in order to select the optimal treatment strategy for each individual patient
  • Interpret new and emerging data for medical therapy and their impact on daily clinical practice
  • Assess the latest changes to best practice for the care of patients with CTEPH

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/5
A presented abstract describing the accuracy of pre-operative specimen level prediction in CTEPH prior to PTE reported which of the following?
Correct

Preoperative prediction of the level of surgical specimen found at PTE had only slight to fair accuracy. When surgical levels were combined into two groups, the preoperative prediction accuracy ranged from 59–72%. Even with CTEPH diagnostic expertise, the surgical specimen level cannot be reliably predicted prior to PTE.

Abbreviations:
CTEPH, chronic thromboembolic pulmonary hypertension; PTE, pulmonary thromboendarterectomy.

Reference:
Pirompanich P et al. Presented at the ERS International Congress 2020 virtual, 06–09 September 2020.

Question 2/5
A single centre, observational study looking at the adherence to guidelines for anticoagulant therapy in patients with CTEPH reported which of the following?
Correct

Out of the 451 patients followed, 426 (94%) adhered to the anticoagulation guidelines.

Abbreviation:
CTEPH, chronic thromboembolic pulmonary hypertension.

Reference:
Rainone R, et al. ERS International Congress 2020 v i r t u a l, 06–09 September 2020.

Question 3/5
A feasibility study investigating sequential multimodal therapy in patients with operable lesions on one side, contralateral surgically inaccessible lesions and high PVR reported which of the following?
Correct

At post-PEA evaluation, 6-min walk distance improved from 321 m to 398 m, mean pulmonary artery pressure decreased from 51 mmHg to 28 mmHg (p=0.031) and PVR from 960 dyn.s.cm-5 to 419 dyn.s.cm-5 (p=0.031). Three patients discontinued medical treatment after surgery. No patients died.

Abbreviation:
PVR, pulmonary vascular resistance.

Reference:
Jevnikar M, et al. ERS International Congress 2020 v i r t u a l, 06–09 September 2020.

Question 4/5
Several presentations looked at pre-operative assessment of patients, which of the following general criteria would you require a patient with CTEPH to meet before assessing them as operable?
Correct

The 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension state that general criteria for the patient operability include preoperative WHO functional class II–IV and surgical accessibility of thrombi in the main, lobar or segmental pulmonary arteries. There is no pulmonary vascular resistance threshold or specific age of patient that can be considered to preclude surgery per se.

Abbreviations:
CTEPH, chronic thromboembolic pulmonary hypertension; ERS, European Respiratory Society; ESC, European Society of Cardiology; WHO, World Health Organization; WU, Wood units.

Reference:
Galiè N et al. Eur Respir J. 2015;46:903–75.

Question 5/5
If your patient is assessed as inoperable, which of the following would be your choice of disease management?
Correct

Riociguat is the currently approved medical therapy in many countries for inoperable CTEPH and its use should be considered in combination with balloon pulmonary angioplasty.1 Macitentan is being considered for potential CTEPH registration but is currently not licensed.1 Life-long anticoagulation is recommended in all patients with CTEPH even after pulmonary endarterectomy.2 Diuretics and oxygen are recommended in cases of heart failure or hypoxemia in combination with other therapy.2

Abbreviation:
CTEPH, chronic thromboembolic pulmonary hypertension.

References:
Kim NH, et al. Eur Respir J. 2019;53:1801915.
Galiè N et al. Eur Respir J. 2015;46:903–75.

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