ERS International Congress, Madrid, 2019: highlights from the Pulmonary Vascular Diseases Assembly

Abstract

The 2019 European Respiratory Society (ERS) International Congress, held in Madrid, Spain, had exciting sessions regarding the field of pulmonary vascular disease. The symposia related to the new ERS/European Society of Cardiology (ESC) Guidelines for the diagnosis and management of acute pulmonary embolism were well received, as were sessions on pulmonary hypertension related to lung disease, demonstrating the concept of pulmonary hypertension not being the rarity that it was previously thought to be. The use of risk stratification in relation to pulmonary arterial hypertension (PAH) was heavily featured and the scientific sessions informing the respiratory community of potential biomarkers and targets for future therapies were thought-provoking. This article discusses highlights of the 2019 pulmonary vascular disease sessions as a summary of current knowledge and practice. We have summarised the key points from the sessions pertaining to the new ERS/ESC Guidelines for the management of acute pulmonary embolism. We have also focused on prognostic factors and potential therapies in pulmonary hypertension related to interstitial lung disease. Relating to PAH, we have reviewed the symposia on risk stratification, along with the use of noninvasive measures and the sessions relating to biomarkers in PAH.

FIGURE 1

Diagnostic algorithm for patients with suspected pulmonary embolism (PE) without haemodynamic instability. CTPA: computed tomography pulmonary angiography. Reproduced and modified from [1] with permission.

FIGURE 2

Risk-adjusted management strategy for acute pulmonary embolism (PE). RV: right ventricular; TTE: transthoracic echocardiography; CTPA: computed tomography pulmonary angiography; PESI: Pulmonary Embolism Severity Index; sPESI: simplified Pulmonary Embolism Severity Index. Reproduced and modified from [1] with permission.

FIGURE 3

Diagnostic work-up and management of suspected pulmonary embolism (PE) during pregnancy and up to 6 weeks post-partum. LMWH: low-molecular-weight heparin; DVT: deep vein thrombosis; CTPA: computed tomography pulmonary angiography. Reproduced and modified from [1] with permission.

FIGURE 4

Follow-up strategy and diagnostic work-up for long-term sequelae of pulmonary embolism (PE). TTE: transthoracic echocardiography; PH: pulmonary hypertension; CTEPH: chronic thromboembolic pulmonary hypertension; NT-proBNP: N-terminal pro-brain natriuretic peptide; CPET: cardiopulmonary exercise test; V′/Q′: ventilation/perfusion. Reproduced and modified from [1] with permission.

FIGURE 5

Evaluation of pulmonary hypertension (PH) in chronic lung disease (CLD). LD: lung disease; FEV₁: forced expiratory volume in 1 s; FVC: forced vital capacity; CT: computed tomography; PAH: pulmonary arterial hypertension; RCT: randomised controlled trial. Reproduced and modified from [31] with permission.