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A Finger-Prick Test for Alzheimer’s Disease?
In a pilot study, researchers found a good correlation of p-tau217 levels from blood obtained via standard venous sampling and from a single finger prick.
“We see the potential that capillary p-tau217 from dried blood spots could overcome the limitations of standard venous collection of being invasive, dependent on centrifuges and ultra-low temperature freezers, and also requiring less volume than standard plasma analysis,” said lead investigator Hanna Huber, PhD, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden.
The findings were presented at the 17th Clinical Trials on Alzheimer’s Disease (CTAD) conference.
Strong Link Between Venous and Capillary Samples
p-tau217 has emerged as the most effective blood test to identify Alzheimer’s disease. However, traditional venous blood sampling requires certain infrastructure and immediate processing. Increased and simplified access to this blood biomarker could be crucial for early diagnosis, proper patient management, and prompt initiation of disease-modifying treatments.
The DROP-AD project is investigating the diagnostic performance of finger-prick collection to accurately measure p-tau217. In the current study, the research team obtained paired venous blood and capillary blood samples from 206 adults (mean age, 71.8 years; 59% women), with or without cognitive impairment, from five European centers. A subset of participants provided a second finger-prick sample collected without any supervision.
The capillary blood samples were obtained via a single finger prick, and then single blood drops were applied to a dried plasma spot (DPS) card, which was then shipped to a lab (without temperature control or cooling) for p-tau217 measurement. Cerebrospinal fluid biomarkers were available for a subset of individuals.
Throughout the entire study population, there was a “very convincing correlation” between p-tau217 levels from capillary DPS and venous plasma, Huber told conference attendees.
Additionally, capillary DPS p-tau217 levels were able to discriminate amyloid-positive from amyloid-negative individuals, with levels of this biomarker increasing in a stepwise fashion, “from cognitively unimpaired individuals to individuals with mild cognitive impairment and, finally, to dementia patients,” Huber said.
Of note, capillary p-tau217 levels from DPS samples that were collected by research staff did not differ from unsupervised self-collected samples.
What about the stability of the samples? Capillary DPS p-tau-217 is “stable over 2 weeks at room temperature,” Huber said.
Ready for Prime Time?
Preliminary data from the DROP-AD project highlight the potential of using finger-prick blood collection to identify neurofilament light (NfL) and glial fibrillary acidic protein (GFAP), two other Alzheimer’s disease biomarkers.
“We think that capillary p-tau217, but also other biomarkers, could be a widely accessible and cheap alternative for clinical practice and clinical trials in individuals with cognitive decline if the results are confirmed in longitudinal and home-sampling cohorts,” Huber concluded.
“Measuring biomarkers by a simple finger prick could facilitate regular and autonomous sampling at home, which would be particularly useful in remote and rural settings,” she noted.
The findings in this study confirm and extend earlier findings that the study team reported last year at the Alzheimer’s Association International Conference (AAIC).
“The data shared at CTAD 2024, along with the related material previously presented at AAIC 2023, reporting on a ‘finger prick’ blood test approach is interesting and emerging work but not yet ready for clinical use,” said Rebecca M. Edelmayer, PhD, Alzheimer’s Association vice president of scientific engagement.
“That said, the idea of a highly accessible and scalable tool that can aid in easier and more equitable diagnosis would be welcomed by researchers, clinicians, and individuals and families affected by Alzheimer’s disease and all other dementias,” Edelmayer said.
“This finger-prick blood testing technology for Alzheimer’s biomarkers still has to be validated more broadly, but it is very promising. Advancements in technology and practice demonstrate the simplicity, transportability, and diagnostic value of blood-based biomarkers for Alzheimer’s,” she added.
The Alzheimer’s Association is currently conducting a systematic review of the evidence and preparing clinical practice guidelines on blood-based biomarker tests for specialized healthcare settings, with publications, clinical resources, and tools anticipated in 2025, Edelmayer noted.
The study had no commercial funding. Huber and Edelmayer report no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
In a pilot study, researchers found a good correlation of p-tau217 levels from blood obtained via standard venous sampling and from a single finger prick.
“We see the potential that capillary p-tau217 from dried blood spots could overcome the limitations of standard venous collection of being invasive, dependent on centrifuges and ultra-low temperature freezers, and also requiring less volume than standard plasma analysis,” said lead investigator Hanna Huber, PhD, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden.
The findings were presented at the 17th Clinical Trials on Alzheimer’s Disease (CTAD) conference.
Strong Link Between Venous and Capillary Samples
p-tau217 has emerged as the most effective blood test to identify Alzheimer’s disease. However, traditional venous blood sampling requires certain infrastructure and immediate processing. Increased and simplified access to this blood biomarker could be crucial for early diagnosis, proper patient management, and prompt initiation of disease-modifying treatments.
The DROP-AD project is investigating the diagnostic performance of finger-prick collection to accurately measure p-tau217. In the current study, the research team obtained paired venous blood and capillary blood samples from 206 adults (mean age, 71.8 years; 59% women), with or without cognitive impairment, from five European centers. A subset of participants provided a second finger-prick sample collected without any supervision.
The capillary blood samples were obtained via a single finger prick, and then single blood drops were applied to a dried plasma spot (DPS) card, which was then shipped to a lab (without temperature control or cooling) for p-tau217 measurement. Cerebrospinal fluid biomarkers were available for a subset of individuals.
Throughout the entire study population, there was a “very convincing correlation” between p-tau217 levels from capillary DPS and venous plasma, Huber told conference attendees.
Additionally, capillary DPS p-tau217 levels were able to discriminate amyloid-positive from amyloid-negative individuals, with levels of this biomarker increasing in a stepwise fashion, “from cognitively unimpaired individuals to individuals with mild cognitive impairment and, finally, to dementia patients,” Huber said.
Of note, capillary p-tau217 levels from DPS samples that were collected by research staff did not differ from unsupervised self-collected samples.
What about the stability of the samples? Capillary DPS p-tau-217 is “stable over 2 weeks at room temperature,” Huber said.
Ready for Prime Time?
Preliminary data from the DROP-AD project highlight the potential of using finger-prick blood collection to identify neurofilament light (NfL) and glial fibrillary acidic protein (GFAP), two other Alzheimer’s disease biomarkers.
“We think that capillary p-tau217, but also other biomarkers, could be a widely accessible and cheap alternative for clinical practice and clinical trials in individuals with cognitive decline if the results are confirmed in longitudinal and home-sampling cohorts,” Huber concluded.
“Measuring biomarkers by a simple finger prick could facilitate regular and autonomous sampling at home, which would be particularly useful in remote and rural settings,” she noted.
The findings in this study confirm and extend earlier findings that the study team reported last year at the Alzheimer’s Association International Conference (AAIC).
“The data shared at CTAD 2024, along with the related material previously presented at AAIC 2023, reporting on a ‘finger prick’ blood test approach is interesting and emerging work but not yet ready for clinical use,” said Rebecca M. Edelmayer, PhD, Alzheimer’s Association vice president of scientific engagement.
“That said, the idea of a highly accessible and scalable tool that can aid in easier and more equitable diagnosis would be welcomed by researchers, clinicians, and individuals and families affected by Alzheimer’s disease and all other dementias,” Edelmayer said.
“This finger-prick blood testing technology for Alzheimer’s biomarkers still has to be validated more broadly, but it is very promising. Advancements in technology and practice demonstrate the simplicity, transportability, and diagnostic value of blood-based biomarkers for Alzheimer’s,” she added.
The Alzheimer’s Association is currently conducting a systematic review of the evidence and preparing clinical practice guidelines on blood-based biomarker tests for specialized healthcare settings, with publications, clinical resources, and tools anticipated in 2025, Edelmayer noted.
The study had no commercial funding. Huber and Edelmayer report no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
In a pilot study, researchers found a good correlation of p-tau217 levels from blood obtained via standard venous sampling and from a single finger prick.
“We see the potential that capillary p-tau217 from dried blood spots could overcome the limitations of standard venous collection of being invasive, dependent on centrifuges and ultra-low temperature freezers, and also requiring less volume than standard plasma analysis,” said lead investigator Hanna Huber, PhD, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden.
The findings were presented at the 17th Clinical Trials on Alzheimer’s Disease (CTAD) conference.
Strong Link Between Venous and Capillary Samples
p-tau217 has emerged as the most effective blood test to identify Alzheimer’s disease. However, traditional venous blood sampling requires certain infrastructure and immediate processing. Increased and simplified access to this blood biomarker could be crucial for early diagnosis, proper patient management, and prompt initiation of disease-modifying treatments.
The DROP-AD project is investigating the diagnostic performance of finger-prick collection to accurately measure p-tau217. In the current study, the research team obtained paired venous blood and capillary blood samples from 206 adults (mean age, 71.8 years; 59% women), with or without cognitive impairment, from five European centers. A subset of participants provided a second finger-prick sample collected without any supervision.
The capillary blood samples were obtained via a single finger prick, and then single blood drops were applied to a dried plasma spot (DPS) card, which was then shipped to a lab (without temperature control or cooling) for p-tau217 measurement. Cerebrospinal fluid biomarkers were available for a subset of individuals.
Throughout the entire study population, there was a “very convincing correlation” between p-tau217 levels from capillary DPS and venous plasma, Huber told conference attendees.
Additionally, capillary DPS p-tau217 levels were able to discriminate amyloid-positive from amyloid-negative individuals, with levels of this biomarker increasing in a stepwise fashion, “from cognitively unimpaired individuals to individuals with mild cognitive impairment and, finally, to dementia patients,” Huber said.
Of note, capillary p-tau217 levels from DPS samples that were collected by research staff did not differ from unsupervised self-collected samples.
What about the stability of the samples? Capillary DPS p-tau-217 is “stable over 2 weeks at room temperature,” Huber said.
Ready for Prime Time?
Preliminary data from the DROP-AD project highlight the potential of using finger-prick blood collection to identify neurofilament light (NfL) and glial fibrillary acidic protein (GFAP), two other Alzheimer’s disease biomarkers.
“We think that capillary p-tau217, but also other biomarkers, could be a widely accessible and cheap alternative for clinical practice and clinical trials in individuals with cognitive decline if the results are confirmed in longitudinal and home-sampling cohorts,” Huber concluded.
“Measuring biomarkers by a simple finger prick could facilitate regular and autonomous sampling at home, which would be particularly useful in remote and rural settings,” she noted.
The findings in this study confirm and extend earlier findings that the study team reported last year at the Alzheimer’s Association International Conference (AAIC).
“The data shared at CTAD 2024, along with the related material previously presented at AAIC 2023, reporting on a ‘finger prick’ blood test approach is interesting and emerging work but not yet ready for clinical use,” said Rebecca M. Edelmayer, PhD, Alzheimer’s Association vice president of scientific engagement.
“That said, the idea of a highly accessible and scalable tool that can aid in easier and more equitable diagnosis would be welcomed by researchers, clinicians, and individuals and families affected by Alzheimer’s disease and all other dementias,” Edelmayer said.
“This finger-prick blood testing technology for Alzheimer’s biomarkers still has to be validated more broadly, but it is very promising. Advancements in technology and practice demonstrate the simplicity, transportability, and diagnostic value of blood-based biomarkers for Alzheimer’s,” she added.
The Alzheimer’s Association is currently conducting a systematic review of the evidence and preparing clinical practice guidelines on blood-based biomarker tests for specialized healthcare settings, with publications, clinical resources, and tools anticipated in 2025, Edelmayer noted.
The study had no commercial funding. Huber and Edelmayer report no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
FROM CTAD 2024
Minor Progress in Gender Pay Equity, But a Big Gap Persists
Despite some recent progress in compensation equity, women in medicine continue to be paid significantly lower salaries than men.
According to the Female Compensation Report 2024 by Medscape, male doctors of any kind earned an average salary of about $400,000, whereas female doctors earned approximately $309,000 — a 29% gap.
The report analyzed survey data from 7000 practicing physicians who were recruited over a 4-month period starting in October 2023. The respondents comprised roughly 60% women representing over 29 specialties.
In the 2022 report, the pay gap between the genders was 32%. But some women in the field argued substantial headway is still needed.
“You can try and pick apart the data, but I’d say we’re not really making progress,” said Susan T. Hingle, MD, an internist in Illinois and president of the American Medical Women’s Association. “A decline by a couple of percentage points is not significantly addressing this pay gap that over a lifetime is huge, can be millions of dollars.”
The gender gap was narrower among female primary care physicians (PCPs) vs medical specialists. Female PCPs earned around $253,000 per year, whereas male PCPs earned about $295,000 per year. Hingle suggested that female PCPs may enjoy more pay equity because health systems have a harder time filling these positions.
On the other hand, the gap for specialists rose from 27% in 2022 to 31% in 2023. Differences in how aggressively women and men negotiate compensation packages may play a role, said Hingle.
“Taking negotiation out of the equation would be progress to me,” said Hingle.
Pay disparity did not appear to be the result of time spent on the job — female doctors reported an average of 49 work hours per week, whereas their male counterparts reported 50 work hours per week.
Meanwhile, the pay gap progressively worsened over time. Among doctors aged 28-34 years, men earned an average of $53,000 more than women. By ages 46-49, men earned an average of $157,000 more than women.
“I had to take my employer to court to get equal compensation, sad as it is to say,” said a hospitalist in North Carolina.
Nearly 60% of women surveyed felt they were not being paid fairly for their efforts, up from less than half reported in Medscape’s 2021 report. Hingle said that this figure may not only reflect sentiments about the compensation gap, but also less support on the job, including fewer physician assistants (PAs), nurses, and administrative staff.
“At my job, I do the work of multiple people,” said a survey respondent. “Junior resident, senior resident, social worker, nurse practitioner, PA — as well as try to be a teacher, researcher, [and] an excellent doctor and have the time to make patients feel as if they are not in a rush.”
Roughly 30% of women physicians said they would not choose to go into medicine again if given the chance compared with 26% of male physicians.
“Gender inequities in our profession have a direct impact,” said Shikha Jain, MD, an oncologist in Chicago and founder of the Women in Medicine nonprofit. “I think women in general don’t feel valued in the care they’re providing.”
Jain cited bullying, harassment, and fewer opportunities for leadership and recognition as factors beyond pay that affect female physicians’ feelings of being valued.
A version of this article first appeared on Medscape.com.
Despite some recent progress in compensation equity, women in medicine continue to be paid significantly lower salaries than men.
According to the Female Compensation Report 2024 by Medscape, male doctors of any kind earned an average salary of about $400,000, whereas female doctors earned approximately $309,000 — a 29% gap.
The report analyzed survey data from 7000 practicing physicians who were recruited over a 4-month period starting in October 2023. The respondents comprised roughly 60% women representing over 29 specialties.
In the 2022 report, the pay gap between the genders was 32%. But some women in the field argued substantial headway is still needed.
“You can try and pick apart the data, but I’d say we’re not really making progress,” said Susan T. Hingle, MD, an internist in Illinois and president of the American Medical Women’s Association. “A decline by a couple of percentage points is not significantly addressing this pay gap that over a lifetime is huge, can be millions of dollars.”
The gender gap was narrower among female primary care physicians (PCPs) vs medical specialists. Female PCPs earned around $253,000 per year, whereas male PCPs earned about $295,000 per year. Hingle suggested that female PCPs may enjoy more pay equity because health systems have a harder time filling these positions.
On the other hand, the gap for specialists rose from 27% in 2022 to 31% in 2023. Differences in how aggressively women and men negotiate compensation packages may play a role, said Hingle.
“Taking negotiation out of the equation would be progress to me,” said Hingle.
Pay disparity did not appear to be the result of time spent on the job — female doctors reported an average of 49 work hours per week, whereas their male counterparts reported 50 work hours per week.
Meanwhile, the pay gap progressively worsened over time. Among doctors aged 28-34 years, men earned an average of $53,000 more than women. By ages 46-49, men earned an average of $157,000 more than women.
“I had to take my employer to court to get equal compensation, sad as it is to say,” said a hospitalist in North Carolina.
Nearly 60% of women surveyed felt they were not being paid fairly for their efforts, up from less than half reported in Medscape’s 2021 report. Hingle said that this figure may not only reflect sentiments about the compensation gap, but also less support on the job, including fewer physician assistants (PAs), nurses, and administrative staff.
“At my job, I do the work of multiple people,” said a survey respondent. “Junior resident, senior resident, social worker, nurse practitioner, PA — as well as try to be a teacher, researcher, [and] an excellent doctor and have the time to make patients feel as if they are not in a rush.”
Roughly 30% of women physicians said they would not choose to go into medicine again if given the chance compared with 26% of male physicians.
“Gender inequities in our profession have a direct impact,” said Shikha Jain, MD, an oncologist in Chicago and founder of the Women in Medicine nonprofit. “I think women in general don’t feel valued in the care they’re providing.”
Jain cited bullying, harassment, and fewer opportunities for leadership and recognition as factors beyond pay that affect female physicians’ feelings of being valued.
A version of this article first appeared on Medscape.com.
Despite some recent progress in compensation equity, women in medicine continue to be paid significantly lower salaries than men.
According to the Female Compensation Report 2024 by Medscape, male doctors of any kind earned an average salary of about $400,000, whereas female doctors earned approximately $309,000 — a 29% gap.
The report analyzed survey data from 7000 practicing physicians who were recruited over a 4-month period starting in October 2023. The respondents comprised roughly 60% women representing over 29 specialties.
In the 2022 report, the pay gap between the genders was 32%. But some women in the field argued substantial headway is still needed.
“You can try and pick apart the data, but I’d say we’re not really making progress,” said Susan T. Hingle, MD, an internist in Illinois and president of the American Medical Women’s Association. “A decline by a couple of percentage points is not significantly addressing this pay gap that over a lifetime is huge, can be millions of dollars.”
The gender gap was narrower among female primary care physicians (PCPs) vs medical specialists. Female PCPs earned around $253,000 per year, whereas male PCPs earned about $295,000 per year. Hingle suggested that female PCPs may enjoy more pay equity because health systems have a harder time filling these positions.
On the other hand, the gap for specialists rose from 27% in 2022 to 31% in 2023. Differences in how aggressively women and men negotiate compensation packages may play a role, said Hingle.
“Taking negotiation out of the equation would be progress to me,” said Hingle.
Pay disparity did not appear to be the result of time spent on the job — female doctors reported an average of 49 work hours per week, whereas their male counterparts reported 50 work hours per week.
Meanwhile, the pay gap progressively worsened over time. Among doctors aged 28-34 years, men earned an average of $53,000 more than women. By ages 46-49, men earned an average of $157,000 more than women.
“I had to take my employer to court to get equal compensation, sad as it is to say,” said a hospitalist in North Carolina.
Nearly 60% of women surveyed felt they were not being paid fairly for their efforts, up from less than half reported in Medscape’s 2021 report. Hingle said that this figure may not only reflect sentiments about the compensation gap, but also less support on the job, including fewer physician assistants (PAs), nurses, and administrative staff.
“At my job, I do the work of multiple people,” said a survey respondent. “Junior resident, senior resident, social worker, nurse practitioner, PA — as well as try to be a teacher, researcher, [and] an excellent doctor and have the time to make patients feel as if they are not in a rush.”
Roughly 30% of women physicians said they would not choose to go into medicine again if given the chance compared with 26% of male physicians.
“Gender inequities in our profession have a direct impact,” said Shikha Jain, MD, an oncologist in Chicago and founder of the Women in Medicine nonprofit. “I think women in general don’t feel valued in the care they’re providing.”
Jain cited bullying, harassment, and fewer opportunities for leadership and recognition as factors beyond pay that affect female physicians’ feelings of being valued.
A version of this article first appeared on Medscape.com.
AGA Research Foundation: You Can Help
To my fellow AGA Members, I’m not the first to tell you that real progress in the diagnosis, treatment, and cure of digestive disease is at risk. Research funding from traditional sources, like the National Institutes of Health, continues to shrink. We can expect even greater cuts on the horizon.
GI investigators in the early stages of their careers are particularly hard hit. They are finding it much more difficult to secure needed federal funding. As a result, many of these investigators are walking away from GI research frustrated by a lack of support.
It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.
You know that research has revolutionized the care of many digestive disease patients. These patients, as well as everyone in the GI field clinicians and researchers alike, have benefited from the discoveries of passionate investigators, past and present.
This is where you can help.
New treatments and devices are the result of years of research. The AGA Research Foundation grants are critical to continuing the GI pipeline.
Help us fund more researchers by supporting the AGA Research Foundation with a year-end donation. Your donation will support young investigators’ research careers and help assure research is continued.
Be gracious, generous and giving to the future of the GI specialty this holiday season. There are three easy ways to give:
Make a tax-deductible donation online at www. foundation.gastro.org.
Send a donation through the mail to:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Or donate over the phone by calling (301) 222-4002. All gifts are tax-deductible to the fullest extent of US law. Join us!
Dr. Camilleri is AGA Research Foundation Chair and Past AGA Institute President. He is a consultant in the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
To my fellow AGA Members, I’m not the first to tell you that real progress in the diagnosis, treatment, and cure of digestive disease is at risk. Research funding from traditional sources, like the National Institutes of Health, continues to shrink. We can expect even greater cuts on the horizon.
GI investigators in the early stages of their careers are particularly hard hit. They are finding it much more difficult to secure needed federal funding. As a result, many of these investigators are walking away from GI research frustrated by a lack of support.
It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.
You know that research has revolutionized the care of many digestive disease patients. These patients, as well as everyone in the GI field clinicians and researchers alike, have benefited from the discoveries of passionate investigators, past and present.
This is where you can help.
New treatments and devices are the result of years of research. The AGA Research Foundation grants are critical to continuing the GI pipeline.
Help us fund more researchers by supporting the AGA Research Foundation with a year-end donation. Your donation will support young investigators’ research careers and help assure research is continued.
Be gracious, generous and giving to the future of the GI specialty this holiday season. There are three easy ways to give:
Make a tax-deductible donation online at www. foundation.gastro.org.
Send a donation through the mail to:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Or donate over the phone by calling (301) 222-4002. All gifts are tax-deductible to the fullest extent of US law. Join us!
Dr. Camilleri is AGA Research Foundation Chair and Past AGA Institute President. He is a consultant in the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
To my fellow AGA Members, I’m not the first to tell you that real progress in the diagnosis, treatment, and cure of digestive disease is at risk. Research funding from traditional sources, like the National Institutes of Health, continues to shrink. We can expect even greater cuts on the horizon.
GI investigators in the early stages of their careers are particularly hard hit. They are finding it much more difficult to secure needed federal funding. As a result, many of these investigators are walking away from GI research frustrated by a lack of support.
It is our hope that physicians have an abundance of new tools and treatments to care for their patients suffering from digestive disorders.
You know that research has revolutionized the care of many digestive disease patients. These patients, as well as everyone in the GI field clinicians and researchers alike, have benefited from the discoveries of passionate investigators, past and present.
This is where you can help.
New treatments and devices are the result of years of research. The AGA Research Foundation grants are critical to continuing the GI pipeline.
Help us fund more researchers by supporting the AGA Research Foundation with a year-end donation. Your donation will support young investigators’ research careers and help assure research is continued.
Be gracious, generous and giving to the future of the GI specialty this holiday season. There are three easy ways to give:
Make a tax-deductible donation online at www. foundation.gastro.org.
Send a donation through the mail to:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Or donate over the phone by calling (301) 222-4002. All gifts are tax-deductible to the fullest extent of US law. Join us!
Dr. Camilleri is AGA Research Foundation Chair and Past AGA Institute President. He is a consultant in the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Unlock the Latest Clinical Updates with the 2024 PG Course OnDemand
Did you miss out on the AGA Postgraduate Course this year?
Visit agau.gastro.org to purchase today for flexible, on-the-go access to the latest clinical advances in the GI field.
- Unparalleled access: Choose when and where you dive into content with convenient access from any computer or mobile device.
- Incredible faculty: Learn from renowned experts who will offer their perspectives on cutting-edge research and clinical guidance.
- Tangible strategies: Expert and early career faculty will guide you through challenging patient cases and provide strategies you can easily implement upon your return to the office.
- Efficient learning: Content is organized by category: GI oncology, neurogastroenterology & motility, obesity, advanced endoscopy, and liver.
- Continuing education: With CME testing integrated directly into each session, you can easily earn up to 16 CME and MOC credits through December 31, 2024.
Did you miss out on the AGA Postgraduate Course this year?
Visit agau.gastro.org to purchase today for flexible, on-the-go access to the latest clinical advances in the GI field.
- Unparalleled access: Choose when and where you dive into content with convenient access from any computer or mobile device.
- Incredible faculty: Learn from renowned experts who will offer their perspectives on cutting-edge research and clinical guidance.
- Tangible strategies: Expert and early career faculty will guide you through challenging patient cases and provide strategies you can easily implement upon your return to the office.
- Efficient learning: Content is organized by category: GI oncology, neurogastroenterology & motility, obesity, advanced endoscopy, and liver.
- Continuing education: With CME testing integrated directly into each session, you can easily earn up to 16 CME and MOC credits through December 31, 2024.
Did you miss out on the AGA Postgraduate Course this year?
Visit agau.gastro.org to purchase today for flexible, on-the-go access to the latest clinical advances in the GI field.
- Unparalleled access: Choose when and where you dive into content with convenient access from any computer or mobile device.
- Incredible faculty: Learn from renowned experts who will offer their perspectives on cutting-edge research and clinical guidance.
- Tangible strategies: Expert and early career faculty will guide you through challenging patient cases and provide strategies you can easily implement upon your return to the office.
- Efficient learning: Content is organized by category: GI oncology, neurogastroenterology & motility, obesity, advanced endoscopy, and liver.
- Continuing education: With CME testing integrated directly into each session, you can easily earn up to 16 CME and MOC credits through December 31, 2024.
VA Awards Grants to Support Adaptive Sports
The US Department of Veterans Affairs (VA) is awarding $15.9 million in grants to fund adaptive sports, recreational activities, and equine therapy for > 15,000 veterans and service members living with disabilities.
Marine Corps veteran Jataya Taylor — who competed in wheelchair fencing at the 2024 Paralympics — experienced mental health symptoms until she began participating in adaptive sports through an organization supported by the VA Adaptive Sports Grant Program.
“Getting involved in adaptive sports was a saving grace for me,” Taylor said. “Participating in these programs got me on the bike to start with, then got me climbing, and eventually it became an important part of my mental health to participate. I found my people. I found my new network of friends.”
Adaptive sports, which are customized to fit the needs of veterans with disabilities, include paralympic sports, archery, cycling, skiing, hunting, rock climbing, and sky diving. Mike Gooler, another Marine Corps veteran, praised the Adaptive Sports Center’s facilities in Crested Butte, Colorado, calling it “nothing short of amazing.”
“[S]ki therapy has been instrumental in helping me navigate through my experiences and injuries,” Gooler said. “Skiing provides me with sense of freedom and empowerment … and having my family by my side, witnessing my progress and sharing the joy of skiing, was truly special.”
The grant program is facilitated and managed by the National Veterans Sports Programs and Special Events Office and will provide grants to 91 national, regional, and community-based programs for fiscal year 2024 across all 50 states, the District of Columbia, Guam, and Puerto Rico.
“These grants give veterans life-changing opportunities,” Secretary of VA Denis McDonough said. “We know adaptive sports and recreational activities can be transformational for veterans living with disabilities, improving their overall physical and mental health, and also giving them important community with fellow heroes who served.”
Information about the awardees and details of the program are available at www.va.gov/adaptivesports and on Facebook at Sports4Vets.
The US Department of Veterans Affairs (VA) is awarding $15.9 million in grants to fund adaptive sports, recreational activities, and equine therapy for > 15,000 veterans and service members living with disabilities.
Marine Corps veteran Jataya Taylor — who competed in wheelchair fencing at the 2024 Paralympics — experienced mental health symptoms until she began participating in adaptive sports through an organization supported by the VA Adaptive Sports Grant Program.
“Getting involved in adaptive sports was a saving grace for me,” Taylor said. “Participating in these programs got me on the bike to start with, then got me climbing, and eventually it became an important part of my mental health to participate. I found my people. I found my new network of friends.”
Adaptive sports, which are customized to fit the needs of veterans with disabilities, include paralympic sports, archery, cycling, skiing, hunting, rock climbing, and sky diving. Mike Gooler, another Marine Corps veteran, praised the Adaptive Sports Center’s facilities in Crested Butte, Colorado, calling it “nothing short of amazing.”
“[S]ki therapy has been instrumental in helping me navigate through my experiences and injuries,” Gooler said. “Skiing provides me with sense of freedom and empowerment … and having my family by my side, witnessing my progress and sharing the joy of skiing, was truly special.”
The grant program is facilitated and managed by the National Veterans Sports Programs and Special Events Office and will provide grants to 91 national, regional, and community-based programs for fiscal year 2024 across all 50 states, the District of Columbia, Guam, and Puerto Rico.
“These grants give veterans life-changing opportunities,” Secretary of VA Denis McDonough said. “We know adaptive sports and recreational activities can be transformational for veterans living with disabilities, improving their overall physical and mental health, and also giving them important community with fellow heroes who served.”
Information about the awardees and details of the program are available at www.va.gov/adaptivesports and on Facebook at Sports4Vets.
The US Department of Veterans Affairs (VA) is awarding $15.9 million in grants to fund adaptive sports, recreational activities, and equine therapy for > 15,000 veterans and service members living with disabilities.
Marine Corps veteran Jataya Taylor — who competed in wheelchair fencing at the 2024 Paralympics — experienced mental health symptoms until she began participating in adaptive sports through an organization supported by the VA Adaptive Sports Grant Program.
“Getting involved in adaptive sports was a saving grace for me,” Taylor said. “Participating in these programs got me on the bike to start with, then got me climbing, and eventually it became an important part of my mental health to participate. I found my people. I found my new network of friends.”
Adaptive sports, which are customized to fit the needs of veterans with disabilities, include paralympic sports, archery, cycling, skiing, hunting, rock climbing, and sky diving. Mike Gooler, another Marine Corps veteran, praised the Adaptive Sports Center’s facilities in Crested Butte, Colorado, calling it “nothing short of amazing.”
“[S]ki therapy has been instrumental in helping me navigate through my experiences and injuries,” Gooler said. “Skiing provides me with sense of freedom and empowerment … and having my family by my side, witnessing my progress and sharing the joy of skiing, was truly special.”
The grant program is facilitated and managed by the National Veterans Sports Programs and Special Events Office and will provide grants to 91 national, regional, and community-based programs for fiscal year 2024 across all 50 states, the District of Columbia, Guam, and Puerto Rico.
“These grants give veterans life-changing opportunities,” Secretary of VA Denis McDonough said. “We know adaptive sports and recreational activities can be transformational for veterans living with disabilities, improving their overall physical and mental health, and also giving them important community with fellow heroes who served.”
Information about the awardees and details of the program are available at www.va.gov/adaptivesports and on Facebook at Sports4Vets.
Revival of the aspiration vs chest tube debate for PSP
Thoracic Oncology and Chest Procedures Network
Pleural Disease Section
Considerable heterogeneity exists in the management of primary spontaneous pneumothorax (PSP). American and European guidelines have been grappling with this question for decades: What is the best way to manage PSP? A 2023 randomized, controlled trial (Marx et al. AJRCCM) sought to answer this.
The study recruited 379 adults aged 18 to 55 years between 2009 and 2015, with complete and first PSP in 31 French hospitals. One hundred eighty-nine patients initially received simple aspiration and 190 received chest tube drainage. The aspiration device was removed if a chest radiograph (CXR) following 30 minutes of aspiration showed lung apposition, with suction repeated up to one time with incomplete re-expansion. The chest tubes were large-bore (16-F or 20-F) and removed 72 hours postprocedure if the CXR showed complete lung re-expansion.
Simple aspiration was statistically inferior to chest tube drainage (29% vs 18%). However, first-line simple aspiration resulted in shorter length of stay, less subcutaneous emphysema, site infection, pain, and one-year recurrence.
Since most first-time PSP occurs in younger, healthier adults, simple aspiration could still be considered as it is better tolerated than large-bore chest tubes. However, with more frequent use of small-bore (≤14-F) catheters, ambulatory drainage could also be a suitable option in carefully selected patients. Additionally, inpatient chest tubes do not need to remain in place for 72 hours, as was this study’s protocol. Society guidelines will need to weigh in on the latest high-quality evidence available for final recommendations.
Thoracic Oncology and Chest Procedures Network
Pleural Disease Section
Considerable heterogeneity exists in the management of primary spontaneous pneumothorax (PSP). American and European guidelines have been grappling with this question for decades: What is the best way to manage PSP? A 2023 randomized, controlled trial (Marx et al. AJRCCM) sought to answer this.
The study recruited 379 adults aged 18 to 55 years between 2009 and 2015, with complete and first PSP in 31 French hospitals. One hundred eighty-nine patients initially received simple aspiration and 190 received chest tube drainage. The aspiration device was removed if a chest radiograph (CXR) following 30 minutes of aspiration showed lung apposition, with suction repeated up to one time with incomplete re-expansion. The chest tubes were large-bore (16-F or 20-F) and removed 72 hours postprocedure if the CXR showed complete lung re-expansion.
Simple aspiration was statistically inferior to chest tube drainage (29% vs 18%). However, first-line simple aspiration resulted in shorter length of stay, less subcutaneous emphysema, site infection, pain, and one-year recurrence.
Since most first-time PSP occurs in younger, healthier adults, simple aspiration could still be considered as it is better tolerated than large-bore chest tubes. However, with more frequent use of small-bore (≤14-F) catheters, ambulatory drainage could also be a suitable option in carefully selected patients. Additionally, inpatient chest tubes do not need to remain in place for 72 hours, as was this study’s protocol. Society guidelines will need to weigh in on the latest high-quality evidence available for final recommendations.
Thoracic Oncology and Chest Procedures Network
Pleural Disease Section
Considerable heterogeneity exists in the management of primary spontaneous pneumothorax (PSP). American and European guidelines have been grappling with this question for decades: What is the best way to manage PSP? A 2023 randomized, controlled trial (Marx et al. AJRCCM) sought to answer this.
The study recruited 379 adults aged 18 to 55 years between 2009 and 2015, with complete and first PSP in 31 French hospitals. One hundred eighty-nine patients initially received simple aspiration and 190 received chest tube drainage. The aspiration device was removed if a chest radiograph (CXR) following 30 minutes of aspiration showed lung apposition, with suction repeated up to one time with incomplete re-expansion. The chest tubes were large-bore (16-F or 20-F) and removed 72 hours postprocedure if the CXR showed complete lung re-expansion.
Simple aspiration was statistically inferior to chest tube drainage (29% vs 18%). However, first-line simple aspiration resulted in shorter length of stay, less subcutaneous emphysema, site infection, pain, and one-year recurrence.
Since most first-time PSP occurs in younger, healthier adults, simple aspiration could still be considered as it is better tolerated than large-bore chest tubes. However, with more frequent use of small-bore (≤14-F) catheters, ambulatory drainage could also be a suitable option in carefully selected patients. Additionally, inpatient chest tubes do not need to remain in place for 72 hours, as was this study’s protocol. Society guidelines will need to weigh in on the latest high-quality evidence available for final recommendations.
AI applications in pediatric pulmonary, sleep, and critical care medicine
Airways Disorders Network
Pediatric Chest Medicine Section
Artificial intelligence (AI) refers to the science and engineering of making intelligent machines that mimic human cognitive functions, such as learning and problem solving.1 Asthma exacerbations in young children were detected reliably by AI-aided stethoscope alone.2 Inhaler use has been successfully tracked using active and passive patient input to cloud-based dashboards.3 Asthma specialists can potentially use this knowledge to intervene in real time or more frequent intervals than the current episodic care.
Sleep trackers using commercial-grade sensors can provide useful information about sleep hygiene, sleep duration, and nocturnal awakenings. An increasing number of “wearables” and “nearables” that utilize AI algorithms to evaluate sleep duration and quality are FDA approved. AI-based scoring of polysomnography data can improve the efficiency of a sleep laboratory. Big data analysis of CPAP compliance in children led to identification of actionable items that can be targeted to improve patient outcomes.4
The use of AI models in clinical decision support can result in fewer false alerts and missed patients due to increased model accuracy. Additionally, large language model tools can automatically generate comprehensive progress notes incorporating relevant electronic medical records data, thereby reducing physician charting time.
These case uses highlight the potential to improve workflow efficiency and clinical outcomes in pediatric pulmonary and critical care by incorporating AI tools in medical decision-making and management.
References
1. McCarthy JF, Marx KA, Hoffman PE, et al. Applications of machine learning and high-dimensional visualization in cancer detection, diagnosis, and management. Ann N Y Acad Sci. 2004;1020:239-262.
2. Emeryk A, Derom E, Janeczek K, et al. Home monitoring of asthma exacerbations in children and adults with use of an AI-aided stethoscope. Ann Fam Med. 2023;21(6):517-525.
3. Jaimini U, Thirunarayan K, Kalra M, Venkataraman R, Kadariya D, Sheth A. How is my child’s asthma?” Digital phenotype and actionable insights for pediatric asthma. JMIR Pediatr Parent. 2018;1(2):e11988.
4. Bhattacharjee R, Benjafield AV, Armitstead J, et al. Adherence in children using positive airway pressure therapy: a big-data analysis [published correction appears in Lancet Digit Health. 2020 Sep;2(9):e455.]. Lancet Digit Health. 2020;2(2):e94-e101.
Airways Disorders Network
Pediatric Chest Medicine Section
Artificial intelligence (AI) refers to the science and engineering of making intelligent machines that mimic human cognitive functions, such as learning and problem solving.1 Asthma exacerbations in young children were detected reliably by AI-aided stethoscope alone.2 Inhaler use has been successfully tracked using active and passive patient input to cloud-based dashboards.3 Asthma specialists can potentially use this knowledge to intervene in real time or more frequent intervals than the current episodic care.
Sleep trackers using commercial-grade sensors can provide useful information about sleep hygiene, sleep duration, and nocturnal awakenings. An increasing number of “wearables” and “nearables” that utilize AI algorithms to evaluate sleep duration and quality are FDA approved. AI-based scoring of polysomnography data can improve the efficiency of a sleep laboratory. Big data analysis of CPAP compliance in children led to identification of actionable items that can be targeted to improve patient outcomes.4
The use of AI models in clinical decision support can result in fewer false alerts and missed patients due to increased model accuracy. Additionally, large language model tools can automatically generate comprehensive progress notes incorporating relevant electronic medical records data, thereby reducing physician charting time.
These case uses highlight the potential to improve workflow efficiency and clinical outcomes in pediatric pulmonary and critical care by incorporating AI tools in medical decision-making and management.
References
1. McCarthy JF, Marx KA, Hoffman PE, et al. Applications of machine learning and high-dimensional visualization in cancer detection, diagnosis, and management. Ann N Y Acad Sci. 2004;1020:239-262.
2. Emeryk A, Derom E, Janeczek K, et al. Home monitoring of asthma exacerbations in children and adults with use of an AI-aided stethoscope. Ann Fam Med. 2023;21(6):517-525.
3. Jaimini U, Thirunarayan K, Kalra M, Venkataraman R, Kadariya D, Sheth A. How is my child’s asthma?” Digital phenotype and actionable insights for pediatric asthma. JMIR Pediatr Parent. 2018;1(2):e11988.
4. Bhattacharjee R, Benjafield AV, Armitstead J, et al. Adherence in children using positive airway pressure therapy: a big-data analysis [published correction appears in Lancet Digit Health. 2020 Sep;2(9):e455.]. Lancet Digit Health. 2020;2(2):e94-e101.
Airways Disorders Network
Pediatric Chest Medicine Section
Artificial intelligence (AI) refers to the science and engineering of making intelligent machines that mimic human cognitive functions, such as learning and problem solving.1 Asthma exacerbations in young children were detected reliably by AI-aided stethoscope alone.2 Inhaler use has been successfully tracked using active and passive patient input to cloud-based dashboards.3 Asthma specialists can potentially use this knowledge to intervene in real time or more frequent intervals than the current episodic care.
Sleep trackers using commercial-grade sensors can provide useful information about sleep hygiene, sleep duration, and nocturnal awakenings. An increasing number of “wearables” and “nearables” that utilize AI algorithms to evaluate sleep duration and quality are FDA approved. AI-based scoring of polysomnography data can improve the efficiency of a sleep laboratory. Big data analysis of CPAP compliance in children led to identification of actionable items that can be targeted to improve patient outcomes.4
The use of AI models in clinical decision support can result in fewer false alerts and missed patients due to increased model accuracy. Additionally, large language model tools can automatically generate comprehensive progress notes incorporating relevant electronic medical records data, thereby reducing physician charting time.
These case uses highlight the potential to improve workflow efficiency and clinical outcomes in pediatric pulmonary and critical care by incorporating AI tools in medical decision-making and management.
References
1. McCarthy JF, Marx KA, Hoffman PE, et al. Applications of machine learning and high-dimensional visualization in cancer detection, diagnosis, and management. Ann N Y Acad Sci. 2004;1020:239-262.
2. Emeryk A, Derom E, Janeczek K, et al. Home monitoring of asthma exacerbations in children and adults with use of an AI-aided stethoscope. Ann Fam Med. 2023;21(6):517-525.
3. Jaimini U, Thirunarayan K, Kalra M, Venkataraman R, Kadariya D, Sheth A. How is my child’s asthma?” Digital phenotype and actionable insights for pediatric asthma. JMIR Pediatr Parent. 2018;1(2):e11988.
4. Bhattacharjee R, Benjafield AV, Armitstead J, et al. Adherence in children using positive airway pressure therapy: a big-data analysis [published correction appears in Lancet Digit Health. 2020 Sep;2(9):e455.]. Lancet Digit Health. 2020;2(2):e94-e101.
Mechanical power: A missing piece in lung-protective ventilation?
Critical Care Network
Mechanical Ventilation and Airways Management Section
The ARDSNet trial demonstrated the importance of low tidal volume ventilation in patients with ARDS, and we have learned to monitor parameters such as plateau pressure and driving pressure (DP) to ensure lung-protective ventilation. What role does the higher respiratory rate play? There is growing evidence that respiratory rate may play an important part in the pathogenesis of ventilator-induced lung injury (VILI) and the dynamic effect of both rate and static pressures needs to be evaluated.
The concept of mechanical power (MP) was formalized in 2016 by Gattinoni, et al and defined as the product of respiratory rate and total inflation energy gained per breath.1 Calculations have been developed for both volume-controlled and pressure-controlled ventilation, including elements such as respiratory rate and PEEP. Studies have shown that increased MP is associated with ICU and hospital mortality, even at low tidal volumes.2 The use of MP remains limited in clinical practice due to its dynamic nature and difficulty of calculating in routine clinical practice but may be a feasible addition to the continuous monitoring outputs on a ventilator. Additional prospective studies are also needed to define the optimal threshold of MP and to compare monitoring strategies using MP vs DP.
References
1. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42(10):1567-1575.
2. Serpa Neto A, Deliberato RO, Johnson AEW, et al. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. 2018;44(11):1914-1922.
Critical Care Network
Mechanical Ventilation and Airways Management Section
The ARDSNet trial demonstrated the importance of low tidal volume ventilation in patients with ARDS, and we have learned to monitor parameters such as plateau pressure and driving pressure (DP) to ensure lung-protective ventilation. What role does the higher respiratory rate play? There is growing evidence that respiratory rate may play an important part in the pathogenesis of ventilator-induced lung injury (VILI) and the dynamic effect of both rate and static pressures needs to be evaluated.
The concept of mechanical power (MP) was formalized in 2016 by Gattinoni, et al and defined as the product of respiratory rate and total inflation energy gained per breath.1 Calculations have been developed for both volume-controlled and pressure-controlled ventilation, including elements such as respiratory rate and PEEP. Studies have shown that increased MP is associated with ICU and hospital mortality, even at low tidal volumes.2 The use of MP remains limited in clinical practice due to its dynamic nature and difficulty of calculating in routine clinical practice but may be a feasible addition to the continuous monitoring outputs on a ventilator. Additional prospective studies are also needed to define the optimal threshold of MP and to compare monitoring strategies using MP vs DP.
References
1. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42(10):1567-1575.
2. Serpa Neto A, Deliberato RO, Johnson AEW, et al. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. 2018;44(11):1914-1922.
Critical Care Network
Mechanical Ventilation and Airways Management Section
The ARDSNet trial demonstrated the importance of low tidal volume ventilation in patients with ARDS, and we have learned to monitor parameters such as plateau pressure and driving pressure (DP) to ensure lung-protective ventilation. What role does the higher respiratory rate play? There is growing evidence that respiratory rate may play an important part in the pathogenesis of ventilator-induced lung injury (VILI) and the dynamic effect of both rate and static pressures needs to be evaluated.
The concept of mechanical power (MP) was formalized in 2016 by Gattinoni, et al and defined as the product of respiratory rate and total inflation energy gained per breath.1 Calculations have been developed for both volume-controlled and pressure-controlled ventilation, including elements such as respiratory rate and PEEP. Studies have shown that increased MP is associated with ICU and hospital mortality, even at low tidal volumes.2 The use of MP remains limited in clinical practice due to its dynamic nature and difficulty of calculating in routine clinical practice but may be a feasible addition to the continuous monitoring outputs on a ventilator. Additional prospective studies are also needed to define the optimal threshold of MP and to compare monitoring strategies using MP vs DP.
References
1. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42(10):1567-1575.
2. Serpa Neto A, Deliberato RO, Johnson AEW, et al. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. 2018;44(11):1914-1922.
Major takeaways from the seventh world symposium on PH
Pulmonary Vascular and Cardiovascular Network
Pulmonary Vascular Disease Section
The core definition of pulmonary hypertension (PH) remains a mean pulmonary arterial pressure (mPAP) > 20 mm Hg, with precapillary PH defined by a pulmonary arterial wedge pressure (PCWP) ≤ 15 mm Hg and pulmonary vascular resistance (PVR) > 2 Wood units (WU), similar to the 2022 European guidelines.1,2 There was recognition of uncertainty in patients with borderline PAWP (12-18 mm Hg) for postcapillary PH.
It’s crucial to phenotype patients, especially those with valvular heart disease, hypertrophic cardiomyopathy, or amyloid cardiomyopathy, and to be cautious when using PAH medications for this PH group.3
Group 3 PH is often underrecognized and associated with poor outcomes, so screening in clinically stable patients is recommended using a multimodal assessment before hemodynamic evaluation. Inhaled treprostinil is recommended for PH associated with interstitial lung disease (ILD). However, the PERFECT trial on PH therapy in COPD was stopped due to safety concerns, highlighting the need for careful evaluation in chronic lung disease (CLD) patients.4 For risk stratification, further emphasis was made on cardiac imaging and hemodynamic data.
Significant progress was made in understanding four key pathways, including bone morphogenetic protein (BMP)/activin signaling. A treatment algorithm based on risk stratification was reinforced, recommending initial triple therapy with parenteral prostacyclin analogs for high-risk patients.5 Follow-up reassessment may include adding an activin-signaling inhibitor for all risk groups except low risk, as well as oral or inhaled prostacyclin for intermediate-low risk groups.
References
1. Kovacs G, Bartolome S, Denton CP, et al. Definition, classification and diagnosis of pulmonary hypertension. Eur Respir J. 2024;2401324. (Online ahead of print.)
2. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2024;61(1):2200879.
3. Maron BA, Bortman G, De Marco T, et al. Pulmonary hypertension associated with left heart disease. Eur Respir J. 2024;2401344. (Online ahead of print.)
4. Shlobin OA, Adir Y, Barbera JA, et al. Pulmonary hypertension associated with lung diseases. Eur Respir J. 2024;2401200. (Online ahead of print.)
5. Chin KM, Gaine SP, Gerges C, et al. Treatment algorithm for pulmonary arterial hypertension. Eur Respir J. 2024;2401325. (Online ahead of print.)
Pulmonary Vascular and Cardiovascular Network
Pulmonary Vascular Disease Section
The core definition of pulmonary hypertension (PH) remains a mean pulmonary arterial pressure (mPAP) > 20 mm Hg, with precapillary PH defined by a pulmonary arterial wedge pressure (PCWP) ≤ 15 mm Hg and pulmonary vascular resistance (PVR) > 2 Wood units (WU), similar to the 2022 European guidelines.1,2 There was recognition of uncertainty in patients with borderline PAWP (12-18 mm Hg) for postcapillary PH.
It’s crucial to phenotype patients, especially those with valvular heart disease, hypertrophic cardiomyopathy, or amyloid cardiomyopathy, and to be cautious when using PAH medications for this PH group.3
Group 3 PH is often underrecognized and associated with poor outcomes, so screening in clinically stable patients is recommended using a multimodal assessment before hemodynamic evaluation. Inhaled treprostinil is recommended for PH associated with interstitial lung disease (ILD). However, the PERFECT trial on PH therapy in COPD was stopped due to safety concerns, highlighting the need for careful evaluation in chronic lung disease (CLD) patients.4 For risk stratification, further emphasis was made on cardiac imaging and hemodynamic data.
Significant progress was made in understanding four key pathways, including bone morphogenetic protein (BMP)/activin signaling. A treatment algorithm based on risk stratification was reinforced, recommending initial triple therapy with parenteral prostacyclin analogs for high-risk patients.5 Follow-up reassessment may include adding an activin-signaling inhibitor for all risk groups except low risk, as well as oral or inhaled prostacyclin for intermediate-low risk groups.
References
1. Kovacs G, Bartolome S, Denton CP, et al. Definition, classification and diagnosis of pulmonary hypertension. Eur Respir J. 2024;2401324. (Online ahead of print.)
2. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2024;61(1):2200879.
3. Maron BA, Bortman G, De Marco T, et al. Pulmonary hypertension associated with left heart disease. Eur Respir J. 2024;2401344. (Online ahead of print.)
4. Shlobin OA, Adir Y, Barbera JA, et al. Pulmonary hypertension associated with lung diseases. Eur Respir J. 2024;2401200. (Online ahead of print.)
5. Chin KM, Gaine SP, Gerges C, et al. Treatment algorithm for pulmonary arterial hypertension. Eur Respir J. 2024;2401325. (Online ahead of print.)
Pulmonary Vascular and Cardiovascular Network
Pulmonary Vascular Disease Section
The core definition of pulmonary hypertension (PH) remains a mean pulmonary arterial pressure (mPAP) > 20 mm Hg, with precapillary PH defined by a pulmonary arterial wedge pressure (PCWP) ≤ 15 mm Hg and pulmonary vascular resistance (PVR) > 2 Wood units (WU), similar to the 2022 European guidelines.1,2 There was recognition of uncertainty in patients with borderline PAWP (12-18 mm Hg) for postcapillary PH.
It’s crucial to phenotype patients, especially those with valvular heart disease, hypertrophic cardiomyopathy, or amyloid cardiomyopathy, and to be cautious when using PAH medications for this PH group.3
Group 3 PH is often underrecognized and associated with poor outcomes, so screening in clinically stable patients is recommended using a multimodal assessment before hemodynamic evaluation. Inhaled treprostinil is recommended for PH associated with interstitial lung disease (ILD). However, the PERFECT trial on PH therapy in COPD was stopped due to safety concerns, highlighting the need for careful evaluation in chronic lung disease (CLD) patients.4 For risk stratification, further emphasis was made on cardiac imaging and hemodynamic data.
Significant progress was made in understanding four key pathways, including bone morphogenetic protein (BMP)/activin signaling. A treatment algorithm based on risk stratification was reinforced, recommending initial triple therapy with parenteral prostacyclin analogs for high-risk patients.5 Follow-up reassessment may include adding an activin-signaling inhibitor for all risk groups except low risk, as well as oral or inhaled prostacyclin for intermediate-low risk groups.
References
1. Kovacs G, Bartolome S, Denton CP, et al. Definition, classification and diagnosis of pulmonary hypertension. Eur Respir J. 2024;2401324. (Online ahead of print.)
2. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Respir J. 2024;61(1):2200879.
3. Maron BA, Bortman G, De Marco T, et al. Pulmonary hypertension associated with left heart disease. Eur Respir J. 2024;2401344. (Online ahead of print.)
4. Shlobin OA, Adir Y, Barbera JA, et al. Pulmonary hypertension associated with lung diseases. Eur Respir J. 2024;2401200. (Online ahead of print.)
5. Chin KM, Gaine SP, Gerges C, et al. Treatment algorithm for pulmonary arterial hypertension. Eur Respir J. 2024;2401325. (Online ahead of print.)
Extending exercise testing using telehealth monitoring in patients with ILD
Diffuse Lung Disease and Lung Transplant Network
Pulmonary Physiology and Rehabilitation Section
The COVID-19 pandemic revolutionized the use of monitoring equipment in general and oxygen saturation monitoring devices as pulse oximeters in specific. The increasing adoption of activity trackers is geared toward promoting an active lifestyle through real-time feedback and continuous monitoring. Patients with interstitial lung diseases (ILDs) suffer from different symptoms; one of the most disabling is dyspnea. Primarily associated with oxygen desaturation, it initiates a detrimental cycle of decreased physical activity, ultimately compromising the overall quality of life.
The use of activity trackers has shown to enhance exercise capacity among ILD and sarcoidosis patients.1
Implementing continuous monitor activity by activity trackers coupled with continuous oxygen saturation can provide a comprehensive tool to follow up with ILD patients efficiently and accurately based on established use of a six-minute walk test (6MWT) and desaturation screen. Combined 6MWT and desaturation screens remain the principal predictors to assess the disease progression and treatment response in a variety of lung diseases, mainly pulmonary hypertension and ILD and serve as a prognostic indicator of those patients.2 One of the test limitations is that the distance walked in six minutes reflects fluctuations in quality of life.3 Also, the test measures submaximal exercise performance rather than maximal exercise capacity.4
Associations have been found in that the amplitude of oxygen desaturation at the end of exercise was poorly reproducible in 6MWT in idiopathic Interstitial pneumonia.5
Considering the mentioned limitations of the classic 6MWT, an alternative approach involves extended desaturation screen using telehealth and involving different activity levels. However, further validation across a diverse spectrum of ILDs remains essential.
References
1. Cho PSP, Vasudevan S, Maddocks M, et al. Physical inactivity in pulmonary sarcoidosis. Lung. 2019;197(3):285-293.
2. Flaherty KR, Andrei AC, Murray S, et al. Idiopathic pulmonary fibrosis: prognostic value of changes in physiology and six-minute-walk test. Am J Respir Crit Care Med. 2006;174(7), 803-809.
3. Olsson LG, Swedberg K, Clark AL, Witte KK, Cleland JG. Six-minute corridor walk test as an outcome measure for the assessment of treatment in randomized, blinded intervention trials of chronic heart failure: a systematic review. Eur Heart J. 2005;26(8):778-793.
4. Ingle L, Wilkinson M, Carroll S, et al. Cardiorespiratory requirements of the 6-min walk test in older patients with left ventricular systolic dysfunction and no major structural heart disease. Int J Sports Med. 2007;28(8):678-684. https://doi.org/10.1055/s-2007-964886
5. Eaton T, Young P, Milne D, Wells AU. Six-minute walk, maximal exercise tests: reproducibility in fibrotic interstitial pneumonia. Am J Respir Crit Care Med. 2005;171(10):1150-1157.
Diffuse Lung Disease and Lung Transplant Network
Pulmonary Physiology and Rehabilitation Section
The COVID-19 pandemic revolutionized the use of monitoring equipment in general and oxygen saturation monitoring devices as pulse oximeters in specific. The increasing adoption of activity trackers is geared toward promoting an active lifestyle through real-time feedback and continuous monitoring. Patients with interstitial lung diseases (ILDs) suffer from different symptoms; one of the most disabling is dyspnea. Primarily associated with oxygen desaturation, it initiates a detrimental cycle of decreased physical activity, ultimately compromising the overall quality of life.
The use of activity trackers has shown to enhance exercise capacity among ILD and sarcoidosis patients.1
Implementing continuous monitor activity by activity trackers coupled with continuous oxygen saturation can provide a comprehensive tool to follow up with ILD patients efficiently and accurately based on established use of a six-minute walk test (6MWT) and desaturation screen. Combined 6MWT and desaturation screens remain the principal predictors to assess the disease progression and treatment response in a variety of lung diseases, mainly pulmonary hypertension and ILD and serve as a prognostic indicator of those patients.2 One of the test limitations is that the distance walked in six minutes reflects fluctuations in quality of life.3 Also, the test measures submaximal exercise performance rather than maximal exercise capacity.4
Associations have been found in that the amplitude of oxygen desaturation at the end of exercise was poorly reproducible in 6MWT in idiopathic Interstitial pneumonia.5
Considering the mentioned limitations of the classic 6MWT, an alternative approach involves extended desaturation screen using telehealth and involving different activity levels. However, further validation across a diverse spectrum of ILDs remains essential.
References
1. Cho PSP, Vasudevan S, Maddocks M, et al. Physical inactivity in pulmonary sarcoidosis. Lung. 2019;197(3):285-293.
2. Flaherty KR, Andrei AC, Murray S, et al. Idiopathic pulmonary fibrosis: prognostic value of changes in physiology and six-minute-walk test. Am J Respir Crit Care Med. 2006;174(7), 803-809.
3. Olsson LG, Swedberg K, Clark AL, Witte KK, Cleland JG. Six-minute corridor walk test as an outcome measure for the assessment of treatment in randomized, blinded intervention trials of chronic heart failure: a systematic review. Eur Heart J. 2005;26(8):778-793.
4. Ingle L, Wilkinson M, Carroll S, et al. Cardiorespiratory requirements of the 6-min walk test in older patients with left ventricular systolic dysfunction and no major structural heart disease. Int J Sports Med. 2007;28(8):678-684. https://doi.org/10.1055/s-2007-964886
5. Eaton T, Young P, Milne D, Wells AU. Six-minute walk, maximal exercise tests: reproducibility in fibrotic interstitial pneumonia. Am J Respir Crit Care Med. 2005;171(10):1150-1157.
Diffuse Lung Disease and Lung Transplant Network
Pulmonary Physiology and Rehabilitation Section
The COVID-19 pandemic revolutionized the use of monitoring equipment in general and oxygen saturation monitoring devices as pulse oximeters in specific. The increasing adoption of activity trackers is geared toward promoting an active lifestyle through real-time feedback and continuous monitoring. Patients with interstitial lung diseases (ILDs) suffer from different symptoms; one of the most disabling is dyspnea. Primarily associated with oxygen desaturation, it initiates a detrimental cycle of decreased physical activity, ultimately compromising the overall quality of life.
The use of activity trackers has shown to enhance exercise capacity among ILD and sarcoidosis patients.1
Implementing continuous monitor activity by activity trackers coupled with continuous oxygen saturation can provide a comprehensive tool to follow up with ILD patients efficiently and accurately based on established use of a six-minute walk test (6MWT) and desaturation screen. Combined 6MWT and desaturation screens remain the principal predictors to assess the disease progression and treatment response in a variety of lung diseases, mainly pulmonary hypertension and ILD and serve as a prognostic indicator of those patients.2 One of the test limitations is that the distance walked in six minutes reflects fluctuations in quality of life.3 Also, the test measures submaximal exercise performance rather than maximal exercise capacity.4
Associations have been found in that the amplitude of oxygen desaturation at the end of exercise was poorly reproducible in 6MWT in idiopathic Interstitial pneumonia.5
Considering the mentioned limitations of the classic 6MWT, an alternative approach involves extended desaturation screen using telehealth and involving different activity levels. However, further validation across a diverse spectrum of ILDs remains essential.
References
1. Cho PSP, Vasudevan S, Maddocks M, et al. Physical inactivity in pulmonary sarcoidosis. Lung. 2019;197(3):285-293.
2. Flaherty KR, Andrei AC, Murray S, et al. Idiopathic pulmonary fibrosis: prognostic value of changes in physiology and six-minute-walk test. Am J Respir Crit Care Med. 2006;174(7), 803-809.
3. Olsson LG, Swedberg K, Clark AL, Witte KK, Cleland JG. Six-minute corridor walk test as an outcome measure for the assessment of treatment in randomized, blinded intervention trials of chronic heart failure: a systematic review. Eur Heart J. 2005;26(8):778-793.
4. Ingle L, Wilkinson M, Carroll S, et al. Cardiorespiratory requirements of the 6-min walk test in older patients with left ventricular systolic dysfunction and no major structural heart disease. Int J Sports Med. 2007;28(8):678-684. https://doi.org/10.1055/s-2007-964886
5. Eaton T, Young P, Milne D, Wells AU. Six-minute walk, maximal exercise tests: reproducibility in fibrotic interstitial pneumonia. Am J Respir Crit Care Med. 2005;171(10):1150-1157.