How will my doctor assess if I am responding to PH treatment?


You and your PH should be regularly assessed during treatment of your PH.

It is important to assess if you are responding to treatment or not. If you are not responding to PH treatment, you may need to try another approved PH medication, or an experimental PH medication.

There is no simple or easy way to assess if you are responding to PH treatment.

Your doctor will not depend on a single symptom (such as less shortness of breath) or single test (such as echocardiogram) to assess your PH.

The best approach is to use a global assessment of your PH. Your doctor will assess your PH in many ways, including: 

  • Your symptoms;
  • Your WHO functional class;
  • Physical examination of your heart and lungs;
  • Your exercise capacity, such as during a 6-minute walk test (6MWT);
  • The size and function of the right ventricle (RV) of your heart which can be assessed either by echocardiography or cardiac MRI;
  • Blood tests, such as the level of brain natriuretic peptide (BNP);

You may notice many signs that you are responding to PH treatment:

  • You feel better;
  • You have less symptoms, such as less difficulty breathing, tiredness, edema, faintness, and chest pain;
  • You are able to be more active physically, and to exercise.

Your doctor will examine you and may find signs that you are responding to PH treatment:

  • The severity of your PH, as measured by your WHO functional classification, is better;
  • The pressure in the veins in your neck (also known as jugular venous pressure) is lower;
  • There is less swelling of your feet and ankles;
  • Your heart sounds better.


Lab tests can also suggest that you are responding to PH treatment:

  • You may walk farther during the 6-minute walk test (6MWT);
  • You may be less short of breath during the 6MWT;
  • The right ventricle (RV) of your heart may get smaller and may work better on ECHO;
  • The systolic blood pressure in the right ventricle (RV systolic pressure = RVSP) may be lower on ECHO;
  • The blood pressure in your pulmonary artery (pulmonary artery pressure = PAP), pulmonary vascular resistance (PVR) and right atrial pressure (RAP) may be lower during right-heart catheterization;
  • Your heart may be working better, as measured by higher cardiac output (CO) during right-heart catheterization;
  • The level of brain natriuretic peptide (BNP) in your blood may be lower.

If you are not responding to PH treatment over 2 - 4 months, your doctor will reassess your PH treatment. Your doctor will consider changing your PH medication to another treatment, or adding another PH medication to your current treatment.

 

6-Minute Walk Test

Echocardiogram (ECHO)

Pulmonary Artery Catheterization