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Editorials |

Pulmonary Arterial Hypertension in ChinaPulmonary Arterial Hypertension in China: Promising News and Some Surprises

Paul M. Hassoun, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine.

Correspondence to: Paul M. Hassoun, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University Department of Medicine, 1830 E Monument St, Room 530, Baltimore, MD 21205; e-mail: phassoun@jhmi.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):276-278. doi:10.1378/chest.11-0558
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In an ever-evolving world and at a time of rapid globalization, the news from China by Zhang et al1 in this issue of CHEST (see page 301) on the survival of patients with pulmonary arterial hypertension (PAH) is refreshing. The authors report the demographics, hemodynamic characteristics, and survival of patients with idiopathic PAH (IPAH) and connective tissue disease-related PAH (CTDPAH) from five referral centers established in China in 2006 for evaluation of pulmonary hypertension in the northern (Beijing Shijitan Hospital, Beijing), eastern (Tongji University School of Medicine, Shanghai), central (Xiangya Hospital of Central-South University, Changsha), southern (Nanjing Medical University, Nanjing), and northeastern (Harbin Medical University, Harbin) regions of China. Using a standard approach for the diagnosis of PAH based on strict hemodynamic criteria obtained by right-sided heart catheterization, Zhang et al1 demonstrate that survival of patients with PAH who are treated with modern therapy has remarkably improved compared with that from their previously reported data of 2007.2 Although retrospective in nature, this remarkable study represents the largest analysis of Chinese patients newly diagnosed with PAH (a total of 276 incident cases) between 2007 and 2009 and treated with the traditional three classes of PAH-specific therapy (ie, endothelin receptor antagonists, phosphodiesterase inhibitors, and IV prostacyclin). The investigators should be commended for their careful work, particularly when one considers the enormous difficulties they had to surmount to perform their analysis, such as creation of the various referral centers to sample disease throughout a vast territory, a lack of uniform health coverage among the regions, and, not least, the tremendous cost of PAH therapy in a country where health coverage may be both problematic and uneven among the different regions. The latter difficulty is somewhat reflected by the fact that only 80% of patients with IPAH and 77% of patients with CTDPAH evaluated by right-sided heart catheterization ended up receiving treatment once diagnosed with PAH.

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