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This activity is provided by an independent medical education grant from Merck Sharp and Dohme LLC.

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    Faculty & Disclosures
    Prof. Jean-Luc Vachiéry

    Hôpital Universitaire de Bruxelles Erasme, Brussels, Belgium

    Prof. Jean-Luc Vachiéry is a clinical professor of cardiology and director of the Pulmonary Vascular Diseases and Heart Failure Clinic at the Hôpital Universitaire de Bruxelles Erasme in Belgium. read more

    He received his board certification in Internal Medicine in 1992 and in Cardiology in 1995. He has authored several articles and book chapters, and participated in many collaborative research projects in the field of pulmonary hypertension. This led to the creation of a clinical unit dedicated to patient management and clinical research in pulmonary hypertension and heart failure in 2008.

    Prof. Vachiéry has co-chaired the Pulmonary Hypertension Council at the International Heart and Lung Society (2002–2005), the Working Group on Pulmonary Circulation and Right Ventricular Function at the European Society of Cardiology (ESC; 2006–2008) and the Working Group on Heart Failure at the Belgian Society of Cardiology (2008–2010). He was a Task Force member and section lead of the European Guidelines on Pulmonary Hypertension (2009, 2015 and 2022). Prof. Vachiéry has chaired the Peripheral Vascular Disease Interdisciplinary Network at the International Society for Heart and Lung Transplantation (ISHLT; 2018–2020) and was chair of the Cardiology Professional Community at the ISHLT (2022–2024). He was a member of the Nucleus Working Group on Right Ventricular Failure and Pulmonary Hypertension at the ESC from 2008 to 2024.

    Prof. Vachiéry was a member of the World Symposium on Pulmonary Hypertension in 2003 (Transplantation and Atrial Septostomy) Task Force and co-chair of the Pulmonary Hypertension Due to Heart and Lung Diseases Task Force in 2013. He chaired the Task Force on Pulmonary Hypertension Due to Left Heart Diseases (PH-LHD) in 2018 and was senior adviser to the PH-LHD Task Force in 2024. He is a member of the scientific steering committee of the World Symposium on Pulmonary Hypertension Association.

    Prof. Vachiéry’s centre is a founding member of the European Reference Network – Lung, Pulmonary Hypertension, where he is part of the Research and Guidelines subcommittee. He acts as an expert for several regulatory agencies and scientific organizations for matters related to medicines and care of pulmonary hypertension.

    Prof. Jean-Luc Vachiéry Discloses: Advisory Board or Panel fees from Acceleron (relationship terminated), Aerovate, Bayer HealthCare (relationship terminated), Boehringer Ingelheim, Enzyvant (now Sumitomo Dainippon Pharma; relationship terminated), Gossamer Bio, Insmed, Janssen, Liquidia and Merck/MSD. Consultancy fees from Acceleron (relationship terminated), Bayer HealthCare (relationship terminated), Gossamer Bio, Insmed, Janssen, Keros, Liquidia and Merck/MSD.
    Prof. Manreet Kanwar

    Allegheny General Hospital, Pittsburgh, PA, USA

    Professor Manreet Kanwar is the medical director of the Mechanical Circulatory Support and Cardiac Transplant Program and the co-director of the Division of Heart Failure and Pulmonary Hypertension at Allegheny General Hospital (AGH) in Pittsburgh, PA, US.read more

    Prof. Kanwar is an advanced heart failure physician with expertise in the management of patients with cardiogenic shock, end stage heart failure, mechanical circulatory support and pulmonary hypertension. A dedicated researcher with over 130 peer reviewed articles, she has conducted several clinical trials as primary investigator in the field of heart failure and pulmonary hypertension. Her research career is focused on the art of decision making using artificial intelligence and machine learning. She was elected to the board of directors for the International Society of Heart and Lung Transplantation and serves on the editorial board for the Journal of Heart and Lung Transplantation. Prof. Kanwar was named as one of Pittsburgh Magazine’s “Best Doctors” in 2019–2024.

    Prof. Manreet Kanwar Discloses: Advisory Board or Panel fees from Abbott and Abiomed. Consultancy fees from Bivacor. Speaker’s Bureau fees from Abiomed.
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    How confident are you in treating patients with PAH?

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    Which risk stratification method do you use most often for your patients with PAH?

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    2022 ESC/ERS risk score
       
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    REVEAL
       
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    Which symptom is typically noticed first by your patients with suspected PAH?

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    Clinical diagnosis of PAH: Signs and steps to diagnosis
    Risk stratification of PAH: Working towards individualized treatment
    Treatment algorithms for PAH: An evolving landscape
    Take CE/CME Test
    Pulmonary Hypertension, Rare Diseases CE/CME accredited

    touchIN CONVERSATION
    A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation. Close

    Pulmonary arterial hypertension: A practical roadmap from diagnosis to treatment

    Faculty Podcast Featured
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    Learning Objectives

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

    • Outline the clinical features of PAH and the steps to diagnosis
    • Recognize the importance of risk stratification of patients with PAH to optimize treatment management
    • Apply current guideline-recommended treatment algorithms and emerging therapeutic agents for PAH
    Overview

    In this activity, two experts share their insights on the diagnosis of PAH, patient risk stratification as part of treatment decision-making and considerations for optimal patient treatment and management in an evolving treatment landscape.

    This activity is jointly provided by USF Health and touchIME. read more

    Target Audience

    Pulmonologists, cardiologists, and the multidisciplinary team involved in the management of suspected PAH.

    USF Accreditation

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Prof. Jean-Luc Vachiéry Discloses: Advisory Board or Panel fees from Acceleron (relationship terminated), Aerovate, Bayer HealthCare (relationship terminated), Boehringer Ingelheim, Enzyvant (now Sumitomo Dainippon Pharma; relationship terminated), Gossamer Bio, Insmed, Janssen, Liquidia and Merck/MSD. Consultancy fees from Acceleron (relationship terminated), Bayer HealthCare (relationship terminated), Gossamer Bio, Insmed, Janssen, Keros, Liquidia and Merck/MSD.

    Prof. Manreet Kanwar Discloses: Advisory Board or Panel fees from Abbott and Abiomed. Consultancy fees from Bivacor. Speaker’s Bureau fees from Abiomed.

    Content reviewer

    Danielle Walker, DNP, APRN, AGNP-C has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Contributors

    Johanna Barry has no financial interests/relationships or affiliations in relation to this activity.

    Adriano Boasso has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

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

    If you have questions regarding credit please contact cpdsupport@usf.edu

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    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 (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Nurses

    USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

    A maximum of 0.75 contact hour may be earned by learners who successfully complete this continuing nursing education activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

    This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

    Date of original release: 24 October 2024. Date credits expire: 24 October 2025.

    If you have any questions regarding credit, please contact cpdsupport@usf.edu

    EBAC® Accreditation

    touchIME is an EBAC® accredited provider since 2023.

    This programme is accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBAC®) for 0.75 hour of effective education time.

    The Accreditation Council for Continuing Medical Education (ACCME®), and the Royal College of Physicians and Surgeons of Canada hold an agreement on mutual recognition on substantive equivalency of accreditation systems with EBAC®.

    Through an agreement between the European Board for Accreditation of Continuing Education for Health Professionals and the American Medical Association (AMA), physicians may convert EBAC® CE credits to AMA PRA Category 1 CreditTM. Information on the process to convert EBAC® credit to AMA credit can be found on the AMA website. Other health care professionals may obtain from the AMA a certificate of having participated in an activity eligible for conversion of credit to AMA PRA Category 1 CreditTM.

    Faculty Disclosure Statement/Conflict of Interest Policy

    In compliance with EBAC® guidelines, all speakers/chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event have been mitigated and declared to the audience prior to the CME activities.

    Requirements for Successful Completion

    Certificates of Completion may be awarded upon successful completion of the post-test and evaluation form. If you have completed one hour or more of effective education through EBAC® accredited CE activities, please contact us at accreditation@touchime.org to receive your EBAC® CE credit certificate. EBAC® grants 1 CE credit for every hour of education completed.

    Date of original release: 24 October 2024. Date credits expire: 24 October 2025.

    Time to Complete: 45 minutes

    If you have any questions regarding the EBAC® credits, please contact accreditation@touchime.org 

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

    Claim Credit
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    Topics covered in this activity

    Pulmonary Hypertension / Rare Diseases
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    This Activity Is Funded By:

    An independent medical education grant from Merck Sharp & Dohme LLC. This activity is jointly provided by USF Health and touchIME. touchIME is an EBAC® accredited provider.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF

    USF is an Equal Opportunity/Affirmative Action/Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    EBAC® 

    touchIME is an EBAC® accredited provider since 2023.

    In compliance with EBAC® guidelines, all speakers/chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event are declared to the audience prior to the CME activities.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals outside the UK.

    Date of original release: 24 October 2024. Date credits expire: 24 October 2025

    Claim Credit
    touchIN CONVERSATION
    Pulmonary arterial hypertension: A practical roadmap from diagnosis to treatment
    0.75 CE/CME credit
    Question 1/5
    What three symptoms are most commonly noticed first by patients with PAH?

    PAH, pulmonary arterial hypertension.

    In a recent study in five European countries, which included information from 1,152 physicians and 572 patients, the three symptoms of PAH that were most commonly noticed first by patients were shortness of breath (91.1%), fatigue (62.8%) and general weakness (32.2%).

    Abbreviation

    PAH, pulmonary arterial hypertension.

    Reference

    Small M, et al.Ther Adv Respir Dis. 2024;18:17534666231218886.

    Question 2/5
    You have a patient with unexplained dyspnoea and you suspect PAH and left heart failure. According to the 2022 ESC/ERS guidelines for the diagnosis and treatment of PH what should your next steps be to confirm the diagnosis?

    CPET, cardiopulmonary exercise testing; CT, computed tomography; ERS, European Respiratory Society; ESC, European Society of Cardiology; PAH, pulmonary arterial hypertension; PFT, pulmonary function test; PH, pulmonary hypertension.

    According to the diagnostic algorithm in the 2022 ESC/ERS guidelines for the diagnosis and treatment of PH, patients with unexplained dyspnoea and/or suspected PH should undergo echocardiogram followed by CPET when heart disease is suspected.

    Abbreviations

    CPET, cardiopulmonary exercise testing; ERS, European Respiratory Society; ESC, European Society of Cardiology; PH, pulmonary hypertension.

    Reference

    Humbert M, et al. Eur Heart J.2022;43:3618–731.

    Question 3/5
    Which of the following variables have a high predictive value when carrying out risk stratification in patients with PAH?

    6MWD, 6-minute walking distance; BNP, brain natriuretic peptide; CPET, cardiopulmonary exercise testing; NT-proBNP, N-terminal pro-BNP; PAH, pulmonary arterial hypertension; PFT, pulmonary function test.

    Several modified versions of the 2015 ESC/ERS risk-stratification tool have been developed, including the Swedish Pulmonary Arterial Hypertension Registry (SPAHR), the Comparative, Prospective Registry of Newly Initiated Therapies for PH (COMPERA), and the French PH Registry (FPHR). Other risk-stratification tools have been developed from the US REVEAL, including the REVEAL 2.0 risk score calculator, and an abridged version (REVEAL Lite 2). In all these studies, WHO-FC, 6MWD, and BNP/NT-proBNP emerged as the variables with the highest predictive value.

    Abbreviations

    6MWD, 6-minute walking distance; BNP, brain natriuretic peptide; CPET, cardiopulmonary exercise testing; ERS, European Respiratory Society; ESC, European Society of Cardiology; NT-proBNP, N-terminal pro-brain natriuretic peptide; PAH, pulmonary arterial hypertension; PFT, pulmonary function test; PH, pulmonary hypertension; WHO-FC, World Health Organization functional class.

    Reference

    Humbert M, et al. Eur Heart J. 2022;43:3618–731.

    Question 4/5
    Your 40 year old female patient is presenting with shortness of breath, fatigue, general weakness and dyspnoea on exertion. Upon further investigation, she also has signs of right HF, syncope, a 6MWD of 150 m and BNP of 810 ng/L. How do you interpret these observations?

    6MWD, 6-minute walking distance; BNP, brain natriuretic peptide; HF, heart failure; PAH, pulmonary arterial hypertension.

    The 2022 ESC/ERS guidelines for the diagnosis and treatment of PH classify a patient with PAH at high risk (defined as a 1-year mortality risk >20%) if they have clinical observations that include signs of right HF, repeated syncope, a 6MWD <165 m and BNP >800 ng/L or NT-proBNP >1,100 ng/L.

    Abbreviations

    6MWD, 6-minute walking distance; BNP, brain natriuretic peptide; ERS, European Respiratory Society; ESC, European Society of Cardiology; HF, heart failure; NT-proBNP, N-terminal pro-BNP; PAH, pulmonary arterial hypertension.

    Reference

    Humbert M, et al. Eur Heart J. 2022;43:3618–731.

    Question 5/5
    A patient who was recently diagnosed with PAH has WHO-FC III symptoms and evidence of rapid disease progression, and is considered to be in the high-risk strata. In addition to initial combination therapy with ambrisentan and tadalafil, assuming the patient can tolerate them, which of the following should you consider as an additional therapy option?

    CCB, calcium channel blocker; PAH, pulmonary arterial hypertension; sGC, soluble guanylate cyclase; WHO-FC, World Health Organization functional class.

    According to the 2019 CHEST guidelines for therapy for PAH in adults, initial treatment with a parenteral prostanoid is advised for patients with PAH who have WHO-FC III symptoms and evidence of rapid disease progression or other markers of poor clinical prognosis.1 In the 2022 ESC/ERS guidelines for the diagnosis and treatment of PH, it is recommended that patients with PAH that are in the high-risk strata have initial therapy consisting of an ERA + PDE5i and IV/SC PCA.2

    Abbreviations

    CHEST, American College of Chest Physicians; ERA, endothelin receptor antagonist; ERS, European Respiratory Society; ESC, European Society of Cardiology; IV, intravenous; PAH, pulmonary arterial hypertension; PCA, prostacyclin analogue; PDE5i, phosphodiesterase-5 inhibitor; PH, pulmonary hypertension; SC, subcutaneous; WHO-FC, World Health Organization functional class.

    References

    1. Klinger JR, et al. Chest. 2019;155:565–86.
    2. Humbert M, et al. Eur Heart J. 2022;43:3618–731.
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    This Activity Is Funded By:

    An independent medical education grant from Merck Sharp & Dohme LLC. This activity is jointly provided by USF Health and touchIME. touchIME is an EBAC® accredited provider.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgement of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF

    USF is an Equal Opportunity/Affirmative Action/Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    EBAC® 

    touchIME is an EBAC® accredited provider since 2023.

    In compliance with EBAC® guidelines, all speakers/chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event are declared to the audience prior to the CME activities.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals outside the UK.

    Date of original release: 24 October 2024. Date credits expire: 24 October 2025

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