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Beyond the 6-Minute Walk Test for Assessing Pediatric Pulmonary HypertensionAssessing Pediatric Pulmonary Hypertension: Making Strides Through Combination End Points

D. Dunbar Ivy, MD; Steven Abman, MD
Author and Funding Information

From the Department of Pediatrics, University of Colorado School of Medicine.

CORRESPONDENCE TO: D. Dunbar Ivy, MD, Section of Cardiology, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO 80045; e-mail: dunbar.ivy@childrenscolorado.org


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts of interest: The University of Colorado contracts with Actelion Pharmaceuticals Ltd, Bayer AG, Gilead, Eli Lilly and Company, and United Therapeutics Corporation for Dr Ivy to be a consultant. Dr Abman has reported 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. See online for more details.


Chest. 2015;148(3):576-577. doi:10.1378/chest.15-0779
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Improving long-term outcomes in pediatric pulmonary hypertension (PH) remains limited by the lack of proven clinical or study end points that can readily be applied to infants and young children. In adult clinical trials for pulmonary arterial hypertension (PAH), the 6-min walk distance has been the most commonly used primary end point to assess clinical course and response to therapeutic interventions.1,2 Event-driven trials that use combined end points have gained favor in adult studies because this approach better captures the key features of the disease course and includes more clinically relevant end points. In the Study With an Endothelin Receptor Antagonist in Pulmonary Arterial Hypertension to Improve Clinical Outcome (SERAPHIN) trial, end points included time to first morbidity or mortality event, including all-cause mortality, atrial septostomy, lung transplantation, the initiation of IV or subcutaneous prostanoids, or other signs of worsening PAH.3 Whether such an approach would also be of value in children with PAH has not been previously studied, and a clear and critical need exists to develop relevant treatment goals that relate to long-term outcomes in children.

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