Tackling the Gray Zone
It is a great honor to take on the role of editor-in-chief of Advances in Pulmonary Hypertension from Dr Richard Channick and to welcome new experts to the editorial board. I'd first like to thank Rich Channick and Deb McBride, managing editor, for paving the way for a relatively smooth transition for me into this role. With this talented and dynamic group of editorial board experts, we intend to continue the Advances commitment to bringing the PH community the latest updates in the field of pulmonary hypertension.
When the editorial board approached me about devoting an issue of Advances to Group 2 pulmonary hypertension, and specifically to pulmonary hypertension (PH) associated with left ventricular diastolic dysfunction, I wondered about whether we would be able to fill the issue with quality content as, admittedly, what we know about managing diastolic dysfunction is less than what we don't know. However, the fact that many of the novel therapies for pulmonary arterial hypertension (PAH; Group 1 PH) can worsen symptoms for a patient with left-sided heart disease reinforced the need to cover this topic and provide clinicians with some tools to ably distinguish PAH (Group 1) patients from PH (Group 2) patients. In this issue, the editorial board and expert authors do an excellent job of highlighting this challenging topic that affects an increasing number of patients encountered within our clinical practices today.
As Dr Myung Park bravely took the lead as guest editor for this issue, she commissioned authors to cover some of the frequently-faced diagnostic dilemmas and management challenges that occur when caring for patients with Group 2 PH. Articles include Dr Francisco Soto's piece on the clinical features that should raise one's suspicion about Group 2 PH. Dr Paul Forfia and Dr Amresh Raina provide us with an eloquent article on non-invasive imaging strategies, and Dr Michael Mathier provides an overview of the hemodynamic nuts and bolts of evaluating patients for Group 2 PH. Both articles describe the diagnostic tools to help us to differentiate between Group 1 (PAH) and Group 2 PH. Finally, Dr Hunter Champion brings forth some general treatment strategies for this challenging group of patients, which underscore the need for further research in this arena.
In this issue, Dr Park and authors as well as section editors have done a terrific job at balancing what we know with what we don't know as it relates to Group 2 Pulmonary Hypertension and begin the dialogue of how we can advance the overall assessment and care of this growing group of PH patients.