RESUMO
Despite the use of enormous personnel and other resources in German weaning centers, approximately 20â% of patients currently fail to get weaned from mechanical ventilation (MV) and need out-of-hospital ventilation.Between 03/2015 and 11/2019, we carried out a pilot project with 33 patients (48â% female, mean age 68â±â11 years at hospital admission) in order to re-evaluate their options of a possible weaning from MV. At this stage the patients had been invasively ventilated for 475â±â775 days. The mean stay in our weaning center was 26â±â19 days. 24/33 (73.53â%) patients were successfully weaned from MV. Of those, 11/24 (44â%) were discharged with non-invasive out-of-hospital ventilation. The completely weaned patients had a survival period of 3 or 12 months (92â% and 77â%), respectively. In those discharged with non-invasive ventilation, the survival period of 3 or months was 91â% and 81â%, respectively. In those discharged with invasive ventilation, this was 86â% and 71â%, respectively.The current results demonstrate that even those undergoing long-term out-of-hospital invasive ventilation can be successfully weaned from MV. Therefore, we suggest regular re-evaluations of weaning opportunities in invasively ventilated ambulatory patients.
Assuntos
Ventilação não Invasiva , Desmame do Respirador , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Projetos Piloto , Respiração ArtificialRESUMO
OBJECTIVES: The assessment of pulmonary single-breath diffusing capacity is a frequently performed diagnostic procedure and considered as an important tool in medical surveillance examinations of pulmonary diseases.The aim of this study was to establish reference equations for pulmonary single-breath diffusing capacity parameters in a representative adult-population across a wide age range and to compare the normative values from this sample with previous ones. METHODS: Diffusing capacity measurement was carried out in 3566 participants (1811 males) of a cross-sectional, population-based survey ("Study of Health in Pomerania - SHIP"). RESULTS: Individuals with cardiopulmonary disorders and current smoking habits were excluded, resulting in 1786 healthy individuals (923 males), aged 20â-â84 years. Prediction equations for both sexes were established by quantile regression analyses, taking into consideration the influence of age, height, weight and former smoking. CONCLUSION: The study provides a novel set of prediction equations for pulmonary single-breath diffusing capacity in an adult Caucasian population. The results are comparable to previously reported equations, underline their importance and draw attention to the need for up-to-date reference equations that adequately take into account both the subjects' origin, age, anthropometric characteristics and the equipment used.
Assuntos
Pneumopatias , Capacidade de Difusão Pulmonar , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fumar , Adulto JovemRESUMO
Pulmonary hypertension (PH) can be diagnosed in the context of connective tissue diseases (CTD) as well as in elderly patients with multiple comorbidities. A correct clinical differential diagnosis and classification is essential before adequate therapeutic decisions can be made. Differential diagnosis of PH in CTD comprises associated pulmonary arterial hypertension (APAH), group 2 or 3 PH (PH arising from left heart or chronic lung disease), chronic thromboembolic PH (PH) and group 5 (e.âg. in the context of terminal renal insufficiency). This is also true of elderly patients in whom the decision has to be made if the increasing number of coincident diseases lead to PH or have to be interpreted as comorbidities. In this manuscript, the differential diagnosis of PH is elucidated, focusing on CTD, in the context of left heart disease and chronic lung disease. Furthermore, criteria are presented facilitating an objective approach in this context.
Assuntos
Diagnóstico Diferencial , Cardiopatias , Hipertensão Pulmonar , Pneumopatias/diagnóstico , Doenças do Tecido Conjuntivo/complicações , Doenças do Tecido Conjuntivo/diagnóstico , Cardiopatias/diagnóstico , Humanos , Hipertensão Pulmonar/diagnósticoRESUMO
At the 6th World Symposium on Pulmonary Hypertension (WSPH), which took place from February 27 until March 1, 2018 in Nice, scientific progress over the past 5 years in the field of pulmonary hypertension (PH) was presented by 13 working groups. The results of the discussion were published as proceedings towards the end of 2018.âOne of the major changes suggested by the WSPH was the lowering of the diagnostic threshold for PH from ≥â25 to >â20âmmHg mean pulmonary arterial pressure, measured by right heart catheterization at rest. In addition, the pulmonary vascular resistance was introduced into the definition of PH, which underlines the importance of cardiac output determination at the diagnostic right heart catheterization.In this article, we discuss the rationale and possible consequences of a changed PH definition in the context of the current literature. Further, we provide a current overview on non-invasive and invasive methods for diagnosis, differential diagnosis, and prognosis of PH, including exercise tests.
Assuntos
Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/terapia , Guias de Prática Clínica como Assunto/normas , Cateterismo Cardíaco , HumanosRESUMO
This document replaces the DGP recommendations published in 1998 and 2013. Based on recent studies and a consensus conference, the indications, choice and performance of the adequate exercise testing method and its necessary technical and staffing setting are discussed. Detailed recommendations are provided: for blood gas analysis and right heart catheterization during exercise, walk tests, spiroergometry, and stress echocardiography. The correct use of different exercise tests is discussed for specific situations in respiratory medicine: exercise induced asthma, obesity, monitoring of rehabilitation or therapeutical interventions, preoperative risk stratification, and evaluation in occupational medicine.
Assuntos
Teste de Esforço/normas , Guias de Prática Clínica como Assunto , Pneumologia/normas , Testes de Função Respiratória/normas , Espirometria/normas , Alemanha , Humanos , Medicina do TrabalhoRESUMO
The increasing importance of intensive care medicine including mechanical ventilation has been accompanied by the demand of weaning opportunities for patients undergoing prolonged mechanical ventilation. Consequently, specialised clinical institutions, focusing on the weaning from mechanical ventilation, have been established since the 1980âs.The present article illustrates the structural development and results of such a specialised institution at the University Medicine Greifswald, using data of 616 patients collected within the past ten years (2006â-â2015). Across the years, a shift in the underlying disease leading to mechanical ventilation can be found, with rising numbers of patients suffering from pneumonia/sepsis and declining numbers of patients who underwent cardiac surgery in advance. The days with mechanical ventilation outside (pâ=â0.004) and within the investigated institution (pâ=â0.02) are significantly declining. The percentage of successfully weaned patients increased from 62.7â% (2006â-â2010) to 77.3â% (2011â-â2015), pâ<â0.001.âConsecutively, the percentage of patients who remained mechanically ventilated decreased from 16.4â% to 9.6â% (pâ<â0.001) and the share of in-hospital deceased patients significantly declined from 20.9â% to 13.0â% (pâ<â0.001). Furthermore, the one-year-survival after hospital discharge in successful weaned patients was 72 percent. The present data, collected at the University Medicine Greifswald are quite comparable to data of other German institutions that are specialised on weaning from mechanical ventilation.
Assuntos
Unidades Hospitalares/organização & administração , Hospitais Universitários/organização & administração , Unidades de Terapia Intensiva/organização & administração , Assistência de Longa Duração/organização & administração , Pneumonia/terapia , Sepse/terapia , Desmame do Respirador/métodos , Idoso , Feminino , Alemanha , Unidades Hospitalares/tendências , Hospitais Universitários/tendências , Humanos , Unidades de Terapia Intensiva/tendências , Assistência de Longa Duração/tendências , Masculino , Pessoa de Meia-Idade , Pneumonia/mortalidade , Sepse/mortalidade , Taxa de Sobrevida/tendências , Desmame do Respirador/tendênciasRESUMO
Investigating reasons for differing life expectancy and prevalence of cardiovascular risk factors between old and new states of the Federal Republic of Germany an epidemiological study in Western Pomeraniaâ-âthe population-based project Study of Health in Pomerania (SHIP)â-âwas planned.Prevalence and incidence of common risk factors, subclinical disorders and clinical diseases have been assessed since 1997 in five-year intervals. The third follow up (SHIP-3) was assessed between 2014 and 2016. In addition, an independent representative population sample was investigated between 2008â-â2012 (SHIP-TREND). Recently, the first follow up of this cohort has been started (SHIP-TREND-1). This paper reports the methodological approaches for detecting pneumological relevant morbidities in this population-based study. It aims to offer insights for potential cooperation with interested research groups.
Assuntos
Doenças Cardiovasculares/mortalidade , Nível de Saúde , Expectativa de Vida , Pneumopatias/mortalidade , Projetos de Pesquisa , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Alemanha/epidemiologia , Humanos , Pneumopatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prevalência , Fatores de Risco , Taxa de Sobrevida , Adulto JovemRESUMO
Usual sleep duration is a heritable trait correlated with psychiatric morbidity, cardiometabolic disease and mortality, although little is known about the genetic variants influencing this trait. A genome-wide association study (GWAS) of usual sleep duration was conducted using 18 population-based cohorts totaling 47 180 individuals of European ancestry. Genome-wide significant association was identified at two loci. The strongest is located on chromosome 2, in an intergenic region 35- to 80-kb upstream from the thyroid-specific transcription factor PAX8 (lowest P=1.1 × 10(-9)). This finding was replicated in an African-American sample of 4771 individuals (lowest P=9.3 × 10(-4)). The strongest combined association was at rs1823125 (P=1.5 × 10(-10), minor allele frequency 0.26 in the discovery sample, 0.12 in the replication sample), with each copy of the minor allele associated with a sleep duration 3.1 min longer per night. The alleles associated with longer sleep duration were associated in previous GWAS with a more favorable metabolic profile and a lower risk of attention deficit hyperactivity disorder. Understanding the mechanisms underlying these associations may help elucidate biological mechanisms influencing sleep duration and its association with psychiatric, metabolic and cardiovascular disease.
Assuntos
Dissonias/genética , Sono/genética , Adulto , Negro ou Afro-Americano/genética , Idoso , Feminino , Estudos de Associação Genética , Estudo de Associação Genômica Ampla , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Autorrelato , População Branca/genéticaRESUMO
Vitamin D has an important role in calcium homeostasis and is known to have various health-promoting effects. Moreover, potential interactions between vitamin D and physical activity have been suggested. This study aims to investigate the relationship between 25-hydroxyvitamin D (25(OH)D) and exercise capacity quantified by cardiopulmonary exercise testing (CPET). For this, 1377 participants from the Study of Health in Pomerania (SHIP-1) and 750 participants from the independent SHIP-TREND cohort were investigated. Standardised incremental exercise tests on a cycle ergometer were performed to assess exercise capacity by VO2 at anaerobic threshold, peakVO2, O2 pulse and peak power output. Serum 25(OH)D levels were measured by an automated chemiluminescence immunoassay. In SHIP-1, 25(OH)D levels were positively associated with all considered parameters of cardiopulmonary exercise capacity. Subjects with high 25(OH)D levels (4th quartile) showed an up to 25% higher exercise capacity compared with subjects with low 25(OH)D levels (1st quartile). All associations were replicated in the independent SHIP-TREND cohort and were independent of age, sex, season and other interfering factors. In conclusion, significant positive associations between 25(OH)D and parameters of CPET were detected in two large cohorts of healthy adults.
Assuntos
Vitamina D/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistema Cardiovascular/metabolismo , Estudos de Coortes , Estudos Transversais , Exercício Físico , Teste de Esforço , Feminino , Frequência Cardíaca , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Atividade Motora , Análise Multivariada , Consumo de Oxigênio , Sistema Respiratório/metabolismo , Fatores SocioeconômicosRESUMO
Chronic obstructive pulmonary disease (COPD) is considered to be a complex and heterogeneous disease comprising multiple components. Its clinical presentation, pattern of functional disturbance, disease presentation and pathology varies tremendously between individuals despite the common feature of incompletely reversible airflow obstruction. It is therefore widely accepted that COPD is characterized by discriminable phenotypes that represent specific patterns of these disease features. COPD phenotypes are believed to correlate with outcome parameters such as severity of symptoms, exacerbations, functional loss or death and to require different treatment algorithms.This survey is the result of presentations that were given during an expert conference. It highlights the significance of major comorbidities, genetic, morphologic and inflammatory COPD-phenotypes and their impact on disease progression and treatment modalities.
Assuntos
Terapia de Alvo Molecular/métodos , Medicina de Precisão/métodos , Doença Pulmonar Obstrutiva Crônica/genética , Doença Pulmonar Obstrutiva Crônica/terapia , Congressos como Assunto , Prova Pericial , Predisposição Genética para Doença/genética , Alemanha , Doença Pulmonar Obstrutiva Crônica/diagnósticoRESUMO
COPD is a heterogeneous disease with a wide range of clinical phenotypes and breath-functional dysfunctions. Cardiopulmonary exercise testing (CPET) allows describing all component parts of breathing and determining exercise capacity and the mechanisms of exercise limitation. From these aspects 64 COPD patient stages II, III and IV according to the conventional GOLD classification were examined by means of CPET to evaluate whether CPET can provide a better functional characterization of COPD than the standard investigation procedures in pulmonary practice.We could show that in pulmonary practice CPET is safely and effectively practicable in stable COPD patients of all GOLD stages. This method allowed a clinical and prognostic disease severity assessment of all patients, proving important differences of peak oxygen uptake in each GOLD stage, so that patients in spite of identical GOLD disease severity were to be assigned to different prognostic groups according CPET criteria. Furthermore, we found relevant differences of individual breath-functional patterns in exercise, which can neither be objectified nor be prognosticated by standard investigation procedures at rest.Therefore CPET allows, aside from an objective clinical and prognostic disease severity assessment, also a breath-functional evaluation in a subtly way in COPD patients reflecting the multidimensional background of the disease with variable dysfunctions in pulmonary ventilation, gas exchange, circulation and muscular function as well as associated cardio vascular comorbidities. The breath-functional phenotyping of the COPD patient seems to be meaningful in particular for an individualised therapy management.
Assuntos
Testes Respiratórios/métodos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria/métodos , Teste de Esforço , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índices de Gravidade do TraumaRESUMO
This report gives an overview on the contributions presented in an expert meeting in February, 2015. They deal with the analysis and evaluation of the multiple dimensions of COPD. This complex disease not only interferes with pulmonary mechanics and gas exchange, but also with cardiopulmonary crosstalk and the ventilator pump. A bulk of inflammatory and microbial activity develops during the progression of disease. As a consequence, systemic effects on muscles, metabolism and psyche develop.The sections consider the value of multiple endpoints in clinical research. Quantifiable parameters of lung mechanics and gas exchange, of exercise tolerance and biomarkers improve the measurability of effects in interventions. However, do we really know in a biological sense what we are measuring? What conclusions can we draw in terms of prognosis?Vice versa, we have to look into the origin and meaning of integrative endpoints e.g. quality or life, dyspnoea and spontaneous physical activity. As a new dimension, the clinical significance of morphological findings in HRCT and MRT is analyzed.
Assuntos
Diagnóstico por Imagem/normas , Prova Pericial/normas , Avaliação de Resultados em Cuidados de Saúde/normas , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Testes de Função Respiratória/normas , HumanosRESUMO
Riociguat is the first clinically available soluble Guanylate-cyclase stimulator (sGC) and representative of a completely new class of drugs. Riociguat is approved for pulmonary arterial hypertension (PAH) and non-operable or recurrent/persistent chronic thromboembolic pulmonary hypertension (CTEPH). Moreover, Riociguat is currently under investigation for a wider spectrum of diseases. This article focusses on its mode of action and clinical trial data. Finally, based on these data, the status of approval, as well as the costs a proposal is given how Riociguat can be integrated in the current treatment of PAH and CTEPH.
Assuntos
Guanilato Ciclase/metabolismo , Hipertensão Pulmonar/tratamento farmacológico , Hipertensão Pulmonar/metabolismo , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/metabolismo , Pirazóis/administração & dosagem , Pirimidinas/administração & dosagem , Receptores Citoplasmáticos e Nucleares/metabolismo , Anti-Hipertensivos/administração & dosagem , Doença Crônica , Fibrinolíticos/administração & dosagem , Humanos , Hipertensão Pulmonar/complicações , Embolia Pulmonar/complicações , Pirazóis/farmacocinética , Pirimidinas/farmacocinética , Receptores Citoplasmáticos e Nucleares/agonistas , Guanilil Ciclase Solúvel , Resultado do TratamentoRESUMO
Dyspnoea is the predominant symptom in patients with pulmonary hypertension (PH) at diagnosis. However, since dyspnoea is nonspecific and often occurs in a number of common diseases, the presence of PH can easily be underdiagnosed.In addition, this symptom underlies a high variability in the subjective perception, therefore further diagnostic procedures are often delayed by the patients.A survey of the incidence and severity of dyspnoea in 372 patients with PAH was conducted by questionnaire in German centres. Age, sex distribution and the range of comorbidities corresponded to the findings of national and international registries.Approximately 99â% of patients reported the presence of dyspnoea on exertion, even at low loads.Remarkably, in 13â% of patients dyspnoea occurs as a paroxysmal symptom, which may lead to the differential diagnosis of bronchial asthma. In addition, the patients who were being followed in specialized PH centres reported an increase in dyspnoea during the last year.The results of the survey on the incidence of dyspnoea in patients with PAH are consistent with the findings of international studies.
Assuntos
Dispneia/diagnóstico , Dispneia/epidemiologia , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Alemanha/epidemiologia , Pesquisas sobre Atenção à Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Unidades de Cuidados Respiratórios/estatística & dados numéricos , Centro Respiratório , Medição de Risco , Distribuição por Sexo , Adulto JovemRESUMO
Dyspnea represents one of the most frequent and heterogeneous symptoms. The term dyspnea describes the subjective perception of an inadequate effort to breathe. In general, acute and chronic forms have to be differentiated. Due to its prognostic implications a structured work-up to find the correct diagnosis is of great importance. Depending on the condition of the patient, simple algorithms including biomarkers, an electrocardiogram, echocardiography and other imaging procedures are used when needed. Especially in its acute appearance life-threatening situations, such as myocardial ischemia, heart failure, pulmonary embolism and pneumothorax have to be rapidly and effectively excluded in the differential diagnostics. In contrast, the underlying diseases in chronic dyspnea are bronchial asthma, chronic obstructive airway diseases, heart failure and a combination of obesity and deconditioning in up to 85 % of all cases. The differential diagnosis needs a structured approach including anamnestic and medical technical methods, aiming an efficient differentiation of cardiac and pulmonary causes. As a high number of patients suffer from more than one significant disease, the differential diagnostic assessment needs to be focused on the assessment of the predominant cause of the dyspnea. For this purpose, exercise tests provide helpful algorithms to answer this question.
Assuntos
Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Dispneia/diagnóstico , Dispneia/etiologia , Pneumopatias/complicações , Pneumopatias/diagnóstico , Cuidados Críticos/métodos , Diagnóstico Diferencial , Humanos , Avaliação de Sintomas/métodosRESUMO
Previous studies indicate that physical performance, being a relevant prognostic parameter for cardiovascular events and mortality, decreases with age. Thus, the maintenance and restoration of physical performance as part of a rehabilitation program is of great interest. In the present study, 35 physically active participants, aged 58â-â78 years, were investigated by cardiopulmonary exercise testing. In comparison to matched participants drawn from an epidemiological study, there was no significant difference in performance g between the two groups. Additionally, oxygen kineticswere incrementally measured in order to evaluate a fairly simple procedure for determining fitness under activities of daily life. Surprisingly, this method did not reveal any clinically relevant association between oxygen kinetics and physical fitness.
Assuntos
Teste de Esforço/estatística & dados numéricos , Consumo de Oxigênio/fisiologia , Condicionamento Físico Humano/estatística & dados numéricos , Aptidão Física/fisiologia , Idoso , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valores de ReferênciaRESUMO
BACKGROUND: In clinical practice, oxygen saturation as measured by photoplethysmography and arterial oxygen tension as determined by blood gas analysis are the parameters used frequently to estimate the oxygen status of a patient. Additionally, the cardiac output CO and the arterial oxygen content CaO2 are critical for the delivery of oxygen DO2 to organs and tissues. So far, CaO2 reference values published by Mertzlufft and Zander (1984) and Siggaard-Andersen (1990) are widely used. The aim of the present study was to reevaluate previously published results using the results of a population-based study. Furthermore, the impact of smoking on CaO2 will be assessed. PATIENTS AND METHODS: Data of 1018 volunteers from the Study of Health in Pomerania (SHIP) were analyzed. CaO2 was calculated from blood gas analysis of capillary blood obtained from a hyperemised ear lobe. Reference value equations controlled for sex, age and smoking were derived with quantile regression analysis and fractional polynomials. RESULTS: Lower limits of normal (LLN) decline with age. Current smoking has no significant influence on LLN for CaO2. CONCLUSION: Sex, age and smoking-specific normal values can be calculated using the current equations.
Assuntos
Envelhecimento/metabolismo , Artérias/metabolismo , Oximetria/estatística & dados numéricos , Oximetria/normas , Oxigênio/sangue , Fumar/sangue , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Simulação por Computador , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Distribuição por SexoRESUMO
BACKGROUND: Superior vena cava syndrome is defined as the lack of central venous inflow through the superior vena cava and can present a life-threatening situation. The acute situation is characterized by dyspnea and requires a fast and effective treatment. METHODS: Using two case reports, endovascular stent therapy for the treatment of acute and subacute superior vena cava syndrome is explained and discussed. RESULTS: In the first case, we introduce a patient with acute dyspnea due to decompensation of a chronic thrombosis of the superior vena cava. The second case displayed the same acute symptoms consisting of acute dyspnea and upper venous congestion due to a tumor-related compression of the superior vena cava. In both cases, the acute situation of superior vena cava syndrome was successfully treated by stent implantation. CONCLUSION: Endovascular treatment of superior vena cava syndrome is an effective option with a high technical success rate.
Assuntos
Prótese Vascular , Dispneia/etiologia , Dispneia/prevenção & controle , Procedimentos Endovasculares/métodos , Stents , Síndrome da Veia Cava Superior/diagnóstico , Síndrome da Veia Cava Superior/cirurgia , Doença Aguda , Idoso , Dispneia/diagnóstico , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
In patients with pulmonary hypertension progressive vascular changes in the lung precede the clinical and hemodynamic manifestations of the disease. Therefore, early diagnosis and timely treatment of the disease are crucial. This has been the topic of an expert meeting in Greifswald, Germany in June 2012. The current definition of pulmonary hypertension requires a mean pulmonary artery pressure ≥ 25 mmHg at rest, a hemodynamic abnormality already reflecting pulmonary vascular changes beyond early disease. There is increasing evidence supporting the concept that a lower pressure threshold at rest or an abnormal pressure response with exercise better characterize early disease. While right heart catheterization at rest remains the diagnostic gold standard other methods for detecting early disease are explored with echocardiography being the most frequently used technique. Targeted therapy has been approved for patients with pulmonary arterial hypertension (PAH, WHO-group I) in functional class II-IV. Preliminary data in functional class I patients suggest therapeutic potential of theses drugs in early disease as well. Current guidelines propose therapeutic goals based on parameters with prognostic importance. However, these recommendations are based on mostly retrospective analyses of pre-treatment data obtained in patients with pulmonary hypertension in functional class II-IV. Therefore, evidence-based therapeutic goals for early interventions in functional class I patients are lacking.