Elevated pulmonary arterial pressure was not among the inclusion criteria, and normal pulmonary pressure was not among the exclusion criteria. In other words, epoprostenol in HF was tested in patients who did not necessarily have a target for pharmacologic effects of the drug. When there is no substrate for therapeutic effects, the drug can cause only side effects, and this is exactly what occurred. I doubt anyone could design a trial for a PH drug in the setting of idiopathic pulmonary arterial hypertension without selecting patients with PH. Meanwhile, the FIRST trial did exactly this, in an HF population, and essentially blocked the use of prostacyclin in patients with HF with secondary PH.