Advances in Pulmonary Hypertension

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Guest Editor's Memo

4th World Symposium Makes History

The 4th World Symposium on Pulmonary Hypertension at Dana Point was a historical event. Composed of 11 working groups in areas of basic science, clinical science, and future perspectives, this 3-day event brought experts in pulmonary vascular disease from all over the world to review the past and current literature, update guidelines and recommendations, and discuss and debate issues regarding the controversies and the future directions in pulmonary arterial hypertension (PAH). What was singularly the most remarkable memory for me was witnessing the collective dedication of the group to reach that elusive, yet definite, goal -finding the cure for PAH, a disease that was recently considered "uniformly fatal." Indeed, one only had to step into the room to feel the incredible energy and excitement of all the participants-we all felt the past, present, and future of PH converging in that moment. 

This meeting marked the 35th anniversary of the 1st World Health Organization Meeting on Pulmonary Hypertension  held in Geneva in 1973, a meeting prompted by the outbreak of aminorex-induced PH. It is a testimony to the unflagging dedication of all involved that we now have 8 FDA-approved therapies with more treatments targeting novel pathways currently being developed. 

In putting this issue together, I have had the privilege of working closely with several key members of the working groups. In addition to bringing you a synopsis of several sections, our goals in this issue were to give you an insider's view on the process of shaping the drafts, personal perspectives on some key controversial issues, and a taste of what we can and should expect at the next World Symposium in 2013.  Furthermore, we present a lively roundtable discussion from Drs Robyn Barst, Marc Humbert, Ivan Robbins, and Lewis Rubin, in which they share their experiences and thoughts from the Dana Point meeting and place this symposium in context with the past ones. I hope you enjoy the journey from an insider's look at the 4th World Symposium from Dana Point. 
 
Myung H. Park, MD
Guest Editor

Editor's Memo

As a participant in the 4th World Symposium on Pulmonary Hypertension, held February 2008 in Dana Point, California, I was struck by several things-first was the beautiful setting. Although Southern California is no Venice, Italy (site of the 3rd World Symposium), the Pacific Ocean certainly holds its own as far as aesthetics are concerned.

Secondly, I was amazed at how much new knowledge has been garnered since the 3rd World Symposium. Dedicated investigators have continued to help unravel the pathogenesis of pulmonary arterial hypertension (PAH) at the cellular and molecular levels. What happens inside the pulmonary vascular cells that drives the disease process is becoming increasingly clear. Although the complexities of this process are daunting, new "targets" for therapy are being identified in a classic demonstration of "bench-to-bedside" research. On the classification front, increased understanding of specific disease entities and drug exposures and their association with PAH have led to important changes in the classification system. On diagnosis, newer modalities such as biomarkers and advanced imaging (MRI) are gaining a foothold in the evaluation and follow-up of the pulmonary hypertension (PH) patient. Great advances have been made with treatment: at the 3rd World Symposium, 3 drugs were FDA-approved for PAH; at the time of the Dana Point meeting, 6 approved therapies were available. These new options lead to an expanded, evidence-based treatment algorithm.

Perhaps most importantly, I was struck by the sheer number and diversity of participants at the 4th World Symposium. In contrast, the prior 3rd World Symposium seemed somewhat more "exclusive," with a relatively limited number of global experts meeting in small groups. I believe this expansion in the demographic of the meeting mirrors the disease itself. No longer is PH a rarefied condition treated in a handful of institutions by high-level experts. With the advent of widely available, effective therapy for PAH, we now have the "hot" disease, of interest to a wide-ranging group of healthcare providers. Educational initiatives and outreach, many generated by the Pulmonary Hyper-tension Association, have clearly taken hold, evidenced by the large and varied audience in Dana Point.

This issue, I hope, will give you the "flavor" of this outstanding meeting. Dr Myung Park, the guest editor, has done a fabulous job gathering several authors, all a co-chair of their respective working groups at the 4th World Symposium. These contributors have provided overviews of their respective com-mittees' discussions and recommendations. For a complete summary of the symposium, read the supplement in the Journal of the American College of Cardiology, July 2009.

I would also like to call your attention to another important, "must read" consensus document from June 2009, published jointly by the American College of Cardiology and American Heart Association, and endorsed by the American Thoracic Society and American College of Chest Physicians. This comprehensive document, edited by Dr Vallerie McLaughlin, summarizes the state of the art in PH.

Finally, in this issue, I am pleased to introduce 4 new features: Article Reviews, Clinical Trials Update, PHRN Corner, and Ask the Expert. These new sections enhance the variety and scope of the journal. I look forward to your feedback, as we are always looking for ways to improve this unique publication. Enjoy.

Richard N. Channick, MD
Editor-in-Chief