Roberto J. Bernardo MD, MS, ATSF

All Publications

• Pericardial Effusions And Sotatercept Therapy in Pulmonary Arterial Hypertension: A Multicenter Real-World Experience. The European respiratory journal Sahay, S., Hernandez, N. V., Al Aaraj, Y., Argula, R. G., Bernardo, R. J., Chavarria, M., Ibecheozor, C., Coons, J. C., Domsic, R. T., Fortin, T., Goodrich-Harris, A., Hickey, G., Ho, T., Kliner, J., Machado, R. F., Rajagopal, S., Risbano, M. G., Sese, D. G., Thenappan, T., Chan, S. Y. 2025

  View details for DOI 10.1183/13993003.01040-2025

  View details for PubMedID 40774808

• Classification and Predictors of Right Ventricular Functional Recovery in Pulmonary Arterial Hypertension. Circulation. Heart failure Rischard, F. P., Bernardo, R. J., Vanderpool, R. R., Kwon, D. H., Acharya, T., Park, M. M., Katrynuik, A., Insel, M., Kubba, S., Badagliacca, R., Larive, A. B., Naeije, R., Garcia, J. G., Beck, G. J., Erzurum, S. C., Frantz, R. P., Hassoun, P. M., Hemnes, A. R., Hill, N. S., Horn, E. M., Leopold, J. A., Rosenzweig, E. B., Tang, W. H., Wilcox, J. D. 2023; 16 (10): e010555

  Abstract

  Normative changes in right ventricular (RV) structure and function have not been characterized in the context of treatment-associated functional recovery (RV functional recovery [RVFnRec]). The aim of this study is to assess the clinical relevance of a proposed RVFnRec definition.We evaluated 63 incident patients with pulmonary arterial hypertension by right heart catheterization and cardiac magnetic resonance imaging at diagnosis and cardiac magnetic resonance imaging and invasive cardiopulmonary exercise testing following treatment (≈11 months). Sex, age, ethnicity matched healthy control subjects (n=62) with 1-time cardiac magnetic resonance imaging and noninvasive cardiopulmonary exercise testing were recruited from the PVDOMICS (Redefining Pulmonary Hypertension through Pulmonary Vascular Disease Phenomics) project. We examined therapeutic cardiac magnetic resonance imaging changes relative to the evidence-based peak oxygen consumption (VO2peak)>15 mL/(kg·min) to define RVFnRec by receiver operating curve analysis. Afterload was measured as mean pulmonary artery pressure, resistance, compliance, and elastance.A drop in RV end-diastolic volume of -15 mL best defined RVFnRec (area under the curve, 0.87; P=0.0001) and neared upper 95% CI RV end-diastolic volume of controls. This cutoff was met by 22 out of 63 (35%) patients which was reinforced by freedom from clinical worsening, RVFnRec 1 out of 21 (5%) versus no RVFnRec 17 out of 42, 40% (log-rank P=0.006). A therapy-associated increase of 0.8 mL/mm Hg in compliance had the best predictive value of RVFnRec (area under the curve, 0.76; [95% CI, 0.64-0.88]; P=0.001). RVFnRec patients had greater increases in stroke volume, and cardiac output at exercise.RVFnRec defined by RV end-diastolic volume therapeutic decrease of -15 mL predicts exercise capacity, freedom from clinical worsening, and nears normalization. A therapeutic improvement of compliance is superior to other measures of afterload in predicting RVFnRec. RVFnRec is also associated with increased RV output reserve at exercise.

  View details for DOI 10.1161/CIRCHEARTFAILURE.123.010555

  View details for PubMedID 37664964

  View details for PubMedCentralID PMC10592283

• Hispanic Ethnicity and Social Determinants of Health in Pulmonary Arterial Hypertension: The Pulmonary Hypertension Association Registry. Annals of the American Thoracic Society Bernardo, R. J., Lu, D., Ramirez, R. L., Hedlin, H., Kawut, S. M., Bull, T., De Marco, T., Ford, H. J., Grinnan, D., Klinger, J. R., McConnell, J. W., Berman-Rosenzweig, E., Shlobin, O. A., Zamanian, R. T., de Jesus Perez, V. A. 2022

  Abstract

  Rationale There is a noticeable underrepresentation of minorities in clinical trials and registries in pulmonary arterial hypertension (PAH). Prior studies evaluating the association between Hispanic ethnicity and clinical outcomes in patients with PAH have not assessed the socioeconomic profile of Hispanic individuals or the significance of social determinants of health in clinical outcomes. Objective To determine the association between Hispanic ethnicity, social determinants of health, and clinical outcomes in PAH. Methods Prospective cohort study of adult participants with PAH enrolled in the Pulmonary Hypertension Association Registry, a multicenter US-based registry of patients treated at Pulmonary Hypertension Care Centers. Participants were classified as Hispanics and non-Hispanic Whites, based on self-reported ethnicity. A comparison of baseline clinical and sociodemographic characteristics between groups was performed as well using absolute standardized differences (ASD). The primary outcome of the study was to assess transplant-free survival between Hispanics and non-Hispanic Whites. A Cox proportional hazards model was used for the multivariable analysis after adjusting for age, sex, PAH etiology, annual income, education level and health insurance. Results A total of 683 individuals were included, 98 (14.3%) of Hispanic ethnicity. Hispanic patients had impaired access to health care (31.6% vs. 12.9% Medicaid/uninsured; ASD 0.35), lower education level (72.6% vs. 94.0% high school graduates or higher; ASD 0.60) and lower annual income (32.0% vs. 17.4% with income <20,000 US dollars; ASD 0.47), as compared with non-Hispanic Whites. Hispanic patients had a higher frequency of ER visits and a higher number of hospitalizations, despite having similar disease severity (incidence rate ratio 1.452, 95% CI 1.326 - 1.590 and 1.428, 95% CI 1.292 - 1.577, respectively). While the unadjusted analysis showed a lower transplant/death hazard ratio for Hispanics (HR 0.47, 95% CI 0.24-0.94; p=0.032), there was no association between Hispanic ethnicity and outcome in the multivariable model after adjusting for social determinants of health and other covariates (HR 0.76, 95% CI 0.35-1.62; p=0.474). Conclusions Hispanic ethnicity was not associated with differences in survival after adjusting for social determinants of health and other factors. Social determinants of health are important to consider when assessing the association between ethnicity and outcomes in PAH.

  View details for DOI 10.1513/AnnalsATS.202109-1051OC

  View details for PubMedID 35239467

• The Right Heart Network and Risk Stratification in Pulmonary Arterial Hypertension. Chest Haddad, F., Contrepois, K., Amsallem, M., Denault, A. Y., Bernardo, R. J., Jha, A., Taylor, S., Arthur Ataam, J., Mercier, O., Kouznetsova, T., Vonk Noordegraaf, A., Zamanian, R. T., Sweatt, A. J. 2021

  Abstract

  Prognosis in pulmonary arterial hypertension (PAH) is closely related to indexes of right ventricular function. A better understanding of their relationship may provide important implications for risk stratification in PAH.Can clinical network graphs inform risk stratification in PAH?The study cohort consisted of 231 patients with PAH followed up for a median of 7.1 years. An undirected, correlation network was used to visualize the relationship between clinical features in PAH. This network was enriched for right heart parameters and included N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP), comprehensive echocardiographic parameters, and hemodynamics, as well as 6-min walk distance (6MWD), vital signs, laboratory data, and diffusing capacity for carbon monoxide (Dlco). Connectivity was assessed by using eigenvector and betweenness centrality to reflect global and regional connectivity, respectively. Cox proportional hazards regression was used to model event-free survival for the combined end point of death or lung transplantation.A network of closely intertwined features centered around NT-proBNP with 6MWD emerging as a secondary hub were identified. Less connected nodes included Dlco, systolic BP, albumin, and sodium. Over the follow-up period, death or transplantation occurred in 92 patients (39.8%). A strong prognostic model was achieved with a Harrell's C-index of 0.81 (0.77-0.85) when combining central right heart features (NT-proBNP and right ventricular end-systolic remodeling index) with 6MWD and less connected nodes (Dlco, systolic BP, albumin, sodium, sex, connective tissue disease etiology, and prostanoid therapy). When added to the baseline risk model, serial change in NT-proBNP significantly improved outcome prediction at 5 years (increase in C-statistic of 0.071 ± 0.024; P = .003).NT-proBNP emerged as a central hub in the intertwined PAH network. Connectivity analysis provides explainability for feature selection and combination in outcome models.

  View details for DOI 10.1016/j.chest.2021.10.045

  View details for PubMedID 34774527

• Mechanics of right ventricular dysfunction in pulmonary arterial hypertension and heart failure with preserved ejection fraction. Cardiovascular diagnosis and therapy Bernardo, R. J., Haddad, F. n., Couture, E. J., Hansmann, G. n., de Jesus Perez, V. A., Denault, A. Y., de Man, F. S., Amsallem, M. n. 2020; 10 (5): 1580–1603

  Abstract

  Right ventricular (RV) dysfunction is the most important determinant of survival in patients with pulmonary hypertension (PH). The manifestations of RV dysfunction not only include changes in global RV systolic function but also abnormalities in the pattern of contraction and synchrony. The effects of PH on the right ventricle have been mainly studied in patients with pulmonary arterial hypertension (PAH). However, with the demographic shift towards an aging population, heart failure with preserved ejection fraction (HFpEF) has become an important etiology of PH in recent years. There are significant differences in RV mechanics, function and adaptation between patients with PAH and HFpEF (with or without PH), which are related to different patterns of remodeling and dysfunction. Due to the unique features of the RV chamber, its connection with the main pulmonary artery and the pulmonary circulation, an understanding of the mechanics of RV function and its clinical significance is mandatory for both entities. In this review, we describe the mechanics of the pressure overloaded right ventricle. We review the different mechanical components of RV dysfunction and ventricular dyssynchrony, followed by insights via analysis of pressure-volume loop, energetics and novel blood flow patterns, such as vortex imaging. We conduct an in-depth comparison of prevalence and characteristics of RV dysfunction in HFpEF and PAH, and summarize key outcome studies. Finally, we provide a perspective on needed and expected future work in the field of RV mechanics.

  View details for DOI 10.21037/cdt-20-479

  View details for PubMedID 33224775

  View details for PubMedCentralID PMC7666917

• "How I Do It": Pulmonary Hypertension Associated with Interstitial Lung Diseases. Chest Jose, A., Sood, N., Elwing, J. M., Akkanti, B., Bajwa, A., Bernardo, R., Estrada, R. A., Sharma, M., Soto, F. J., Tonelli, A. R., Verma, D., Vintch, J., Sahay, S., Shlobin, O. A. 2025

  Abstract

  Interstitial Lung Disease (ILD) is a term encompassing a wide array of pulmonary conditions characterized by inflammation and fibrosis of the pulmonary parenchyma. Pulmonary hypertension (PH) is frequently encountered in patients with fibrotic ILDs and poses unique difficulties for both diagnosis and management. Patients with ILD associated pulmonary hypertension (ILD-PH) are complex, often ailing and presenting with multiple comorbidities whose individual contributions to the underlying PH can be challenging to disentangle. Evidence supporting treatment with PH-specific medications in ILD-PH is limited. This edition of "How I Do It" presents a longitudinal case-based discussion of ILD-PH to address these challenges, highlight pearls and pitfalls in the diagnostic workup of these patients, and provide a framework for the practical evidence-based approach to accurate diagnosis and management of these challenging patients.

  View details for DOI 10.1016/j.chest.2025.07.4107

  View details for PubMedID 40939937

• Direct factor Xa inhibitors versus low molecular weight heparins or vitamin K antagonists for prevention of venous thromboembolism in elective primary hip or knee replacement or hip fracture repair. The Cochrane database of systematic reviews Salazar, C. A., Basilio Flores, J. E., Malaga, G., Malasquez, G. N., Bernardo, R. 2025; 1: CD011762

  Abstract

  BACKGROUND: People undergoing major orthopaedic surgery are at increased risk of postoperative thromboembolic events. Low molecular weight heparins (LMWHs) are recommended for thromboprophylaxis in this population. New oral anticoagulants, including direct factor Xa inhibitors, are recommended as alternatives. They may have more advantages than disadvantages compared to LMWHs and vitamin K antagonists (VKAs, another type of anticoagulant).OBJECTIVES: To assess the benefits and harms of prophylactic anticoagulation with direct factor Xa inhibitors compared with low molecular weight heparins and vitamin K antagonists in people undergoing major orthopaedic surgery for elective total hip or knee replacement or hip fracture surgery.SEARCH METHODS: We searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, two other databases, and two trial registers to 11 November 2023. We conducted reference checks to identify additional studies.SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing the effects of direct factor Xa inhibitors to LMWHs or VKAs in people undergoing major orthopaedic surgery.DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were all-cause mortality, major venous thromboembolism (VTE), symptomatic VTE, major bleeding, and serious hepatic and non-hepatic adverse events. We evaluated the risk of bias in the included studies using Cochrane's risk of bias 1 tool. We calculated estimates of treatment effects using risk ratios (RR) with 95% confidence intervals (CIs), and used GRADE criteria to assess the certainty of the evidence.MAIN RESULTS: We included 53 RCTs (44,371 participants). Participants' average age was 64 years (range: 18 to 93 years). Only one RCT compared a VKA with direct factor Xa inhibitors. All 53 RCTs compared direct factor Xa inhibitors with LMWHs. Twenty-three studies included participants undergoing total hip replacement; 21 studies, total knee replacement; and three studies included people having hip fracture surgery. The studies' average duration was approximately 42 days (range: two to 720 days). Compared to LMWHs, direct factor Xa inhibitors may have little to no effect on all-cause mortality, but the evidence is very uncertain (RR 0.83, 95% CI 0.52 to 1.31; I2 = 0%; 28 studies, 29,698 participants; very low-certainty evidence). Direct factor Xa inhibitors may make little to no difference to major venous thromboembolic events compared to LMWHs, but the evidence is very uncertain (RR 0.51, 95% CI 0.37 to 0.71; absolute risk difference: 12 fewer major VTE events per 1000 participants, 95% CI 16 fewer to 7 fewer; I2 = 48%; 28 studies, 24,574 participants; very low-certainty evidence). Compared to LMWHs, direct factor Xa inhibitors may reduce symptomatic VTE (RR 0.64, 95% CI 0.50 to 0.83; I2 = 0%; 33 studies, 31,670 participants; low-certainty evidence). The absolute benefit of substituting factor Xa inhibitors for LMWHs may be between two and five fewer symptomatic VTE episodes per 1000 patients. In the meta-analysis with all studies pooled, direct factor Xa inhibitors appeared to make little or no difference to major bleeding compared to LMWHs, but the evidence was very uncertain (RR 1.05, 95% CI 0.86 to 1.30; I2 = 15%; 36 studies, 39,778 participants; very low certainty-evidence). In a subgroup analysis limited to studies comparing rivaroxaban to LMWHs, people given rivaroxaban may have had more major bleeding events (RR 1.94, 95% CI 1.26 to 2.98; I2 = 0%; 17 studies, 17,630 participants; low-certainty evidence). The absolute risk of substituting rivaroxaban for LMWH may be between one and seven more major bleeding events per 1000 patients. In a subgroup analysis limited to studies comparing direct factor Xa inhibitors other than rivaroxaban to LMWHs, people given these other direct factor Xa inhibitors may have had fewer major bleeding events, but the evidence was very uncertain (RR 0.80, 95% CI 0.63 to 1.02; absolute risk difference: 3 fewer major bleeding events per 1000 participants, 95% CI 5 fewer to 0 fewer; I2 = 0%; 19 studies, 22,148 participants; very low-certainty evidence). Direct factor Xa inhibitors may make little to no difference in serious hepatic adverse events compared to LMWHs, but the evidence is very uncertain (RR 3.01, 95% CI 0.12 to 73.93; 2 studies, 3169 participants; very low-certainty evidence). Only two studies reported this outcome, with one death in the intervention group due to hepatitis reported in one study, and no events reported in the other study. People given direct factor Xa inhibitors may have a lower risk of serious non-hepatic adverse events than those given LMWHs (RR 0.89, 95% CI 0.81 to 0.97; I2 = 18%; 15 studies, 26,246 participants; low-certainty evidence). The absolute benefit of substituting factor Xa inhibitors for LMWH may be between three and 14 fewer serious non-hepatic adverse events per 1000 patients. Only one study compared a direct factor Xa inhibitor with a VKA. It reported outcome data with imprecise results due to the small number of events. It showed no difference in the effects of the study drugs.AUTHORS' CONCLUSIONS: Oral direct factor Xa inhibitors may have little to no effect on all-cause mortality, but the evidence is very uncertain. Oral direct factor Xa inhibitors may slightly reduce symptomatic VTE events when compared with LMWH. They may make little or no difference to major VTE events, but the evidence is very uncertain. In the evaluation of major bleeding, the evidence suggests rivaroxaban results in a slight increase in major bleeding events compared to LMWHs. The remaining oral direct factor Xa inhibitors may have little to no effect on major bleeding, but the evidence is very uncertain. Oral direct factor Xa inhibitors may reduce serious non-hepatic adverse events slightly compared to LMWHs. They may have little to no effect on serious hepatic adverse events, but the evidence is very uncertain. Due to the high rates of missing participants and selective outcome reporting, the effect estimates may be biased.

  View details for DOI 10.1002/14651858.CD011762.pub2

  View details for PubMedID 39868562

• Health Care Disparities in Pulmonary Arterial Hypertension. Clinics in chest medicine Bernardo, R. J., de Jesus Perez, V. A. 2023; 44 (3): 543-554

  Abstract

  The current approach for the management of pulmonary arterial hypertension (PAH) relies on data gathered from clinical trials and large registries. However, there is concern that minorities including Black, Indigenous, and People of Color are underrepresented in these trials and registries, making current data not generalizable to these groups of patients. Hence, it is important to discuss the significance of race/ethnicity and socioeconomic factors in patients with PAH. Here, we review the current knowledge on health care disparities in PAH. We also propose future steps in the global task of assuring justice and equality in access to pulmonary hypertension health care.

  View details for DOI 10.1016/j.ccm.2023.03.010

  View details for PubMedID 37517834

• Access to Medically Necessary Reproductive Care for Individuals with Pulmonary Hypertension. American journal of respiratory and critical care medicine Sonntag, E., Akgun, K. M., Bag, R., Rosensweig, E. B., Bernardo, R. J., Burnetti, C., Chybowski, A., de Jesus Perez, V. A., Diwan, J., Guthrie, K. M., Halscott, T., Lahm, T., Vaught, J., Ventetuolo, C. E., Hemnes, A. R. 2023

  View details for DOI 10.1164/rccm.202302-0230VP

  View details for PubMedID 37311249

• Use of Aerosolized Prostacyclins in Critically Ill Patients and Association With Clinical Outcomes CRITICAL CARE EXPLORATIONS Hussain, S., Jaliawala, H. A., Zhao, D., Ijaz, S., Tsui, J., Chasteen, B., Brown, B. R., Bernardo, R. J. 2023; 5 (1): e0845

  Abstract

  Aerosolized prostacyclins are frequently used in patients with severe acute respiratory distress syndrome and refractory hypoxia. Previous studies have shown improvement in oxygenation with use of pulmonary vasodilators such as iloprost and epoprostenol; however, there is no head-to-head comparison between these agents.To compare the effects of inhaled epoprostenol and inhaled iloprost in critically ill patients with refractory hypoxia.We performed a retrospective cohort analysis of patients admitted to the ICUs at the University of Oklahoma Health Sciences Center between 2015 and 2018. Adult patients who received aerosolized epoprostenol or iloprost for more than 4 hours were included in the analysis.The primary endpoint measured was to compare the change in Pao2/Fio2 ratio between patients treated with iloprost compared with epoprostenol. Secondary outcomes measured were 90-day in-hospital mortality and improvement in vasopressor requirements.A total of 126 patients were included in the study, 95 of whom received iloprost (75%) and 31 patients (25%) received epoprostenol. There were significant improvements in Pao2/Fio2 ratio in both the iloprost and epoprostenol group. Patients in the epoprostenol group appeared to have a higher 90-day mortality compared with the iloprost group. However, our study was not powered to detect a mortality difference and this finding likely represents a sicker population in the epoprostenol group and prescription bias. The use of iloprost was associated with higher vasopressor requirements in the first 12 hours of administration, an association was not observed in the epoprostenol group.In this retrospective cohort analysis, use of both pulmonary vasodilators was associated with similar improvement in gas exchange. The mortality difference observed likely represents difference in severity of illness. Further studies are needed to corroborate these findings.

  View details for DOI 10.1097/CCE.0000000000000845

  View details for Web of Science ID 001275993400018

  View details for PubMedID 36699246

  View details for PubMedCentralID PMC9829278

• The social and economic disadvantage in pulmonary hypertension: A work (still) in progress. Pulmonary circulation Bernardo, R. J., de Jesus Perez, V. 2023; 13 (1): e12196

  View details for DOI 10.1002/pul2.12196

  View details for PubMedID 36788943

• Assessment of Pulmonary Vascular Disease: Pulmonary Vascular Resistance, Exercise Hemodynamics, and Ventriculovascular Coupling. American journal of respiratory and critical care medicine Przebinda, A. S., El Haj Chehade, A., Farooqui, S. M., Youness, H. A., Bernardo, R. J. 2022; 205 (11): 1349

  View details for DOI 10.1164/rccm.202107-1611RR

  View details for PubMedID 35333146

• Letter by Hussain and Bernardo Regarding Article, "Acute Impact of Prone Positioning on the Right Ventricle in COVID-19-Associated Acute Respiratory Distress Syndrome" CIRCULATION-HEART FAILURE Hussain, S. T., Bernardo, R. J. 2022; 15 (5): e009197

  View details for DOI 10.1161/CIRCHEARTFAILURE.121.009197

  View details for Web of Science ID 000793999900011

  View details for PubMedID 35189686

• Left Brachiocephalic Perforation During Right Heart Catheterization. JACC. Case reports Farooqui, S. M., North, J., Bernardo, R. J. 2022; 4 (8): 497-500

  Abstract

  Right heart catheterization is overall considered a safe procedure, although complications can arise from venous access injuries, arrhythmias, vasovagal episodes, and pulmonary artery rupture. We present a case of left brachiocephalic vein perforation during a diagnostic right heart catheterization, which was managed conservatively. (Level of Difficulty: Beginner.).

  View details for DOI 10.1016/j.jaccas.2022.02.013

  View details for PubMedID 35493800

• A second hit? Pulmonary arterial hypertension, <i>BMPR2</i> mutation, and exposure to prescription amphetamines PULMONARY CIRCULATION Jaliawala, H. A., Parmar, M., Summers, K., Bernardo, R. J. 2022; 12 (1): e12053

  Abstract

  The second hit hypothesis in pulmonary hypertension refers to the development of pulmonary vascular disease in individuals at risk, after an additional exposure or "hit" to factors with potential injury to the pulmonary circulation, such as drugs or toxins. We here present a case of severe pulmonary hypertension diagnosed during the third trimester of pregnancy, in a patient with familial history of pulmonary hypertension, found to have a heterozygous mutation in the BMPR2 gene, who also had chronic exposure to prescription amphetamines. We hypothesize that exposure to prescription amphetamines could act as a second hit of pulmonary vascular injury in individuals at risk of pulmonary vascular disease.

  View details for DOI 10.1002/pul2.12053

  View details for Web of Science ID 000773553200001

  View details for PubMedID 35506068

  View details for PubMedCentralID PMC9052970

• Pulmonary vasodilator treatment in pulmonary hypertension due to left heart or lung disease: time for a high-definition picture? Pulmonary circulation Piccari, L., Bernardo, R. J., Rodriguez-Chiaradia, D., Vitulo, P., Wort, S. J., Sahay, S. 2021; 11 (2): 20458940211018074

  View details for DOI 10.1177/20458940211018074

  View details for PubMedID 34104424

• Prescription Patterns for Pulmonary Vasodilators in the Treatment of Pulmonary Hypertension Associated With Chronic Lung Diseases: Insights From a Clinician Survey. Frontiers in medicine Thomas, C. A., Lee, J., Bernardo, R. J., Anderson, R. J., Glinskii, V., Sung, Y. K., Kudelko, K., Hedlin, H., Sweatt, A., Kawut, S. M., Raj, R., Zamanian, R. T., de Jesus Perez, V. 1800; 8: 764815

  Abstract

  Background: Pulmonary hypertension is a complication of chronic lung diseases (PH-CLD) associated with significant morbidity and mortality. Management guidelines for PH-CLD emphasize the treatment of the underlying lung disease, but the role of PH-targeted therapy remains controversial. We hypothesized that treatment approaches for PH-CLD would be variable across physicians depending on the type of CLD and the severity of PH. Methods and Results: Between May and July 2020, we conducted an online survey of PH experts asking for their preferred treatment approach in seven hypothetical cases of PH-CLD of varying severity. We assessed agreement amongst clinicians for initial therapy choice using Fleiss' kappa calculations. Over 90% of respondents agreed that they would treat cases of severe PH in the context of mild lung disease with some form of PH-targeted therapy. For cases of severe PH in the context of severe lung disease, over 70% of respondents agreed to use PH-targeted therapy. For mild PH and mild lung disease cases, <50% of respondents chose to start PH-specific therapy. There was overall poor agreement between respondents in the choice to use mono-, double or triple combination therapy with PH-specific agents in all cases. Conclusion: Although management guidelines discourage the routine use of PH-targeted therapies to treat PH-CLD patients, most physicians choose to treat patients with some form of PH-targeted therapy. The choice of therapy and treatment approach are variable and appear to be influenced by the severity of the PH and the underlying lung disease.

  View details for DOI 10.3389/fmed.2021.764815

  View details for PubMedID 34926507

• Two Cases of Pulmonary Tumor Thrombotic Microangiopathy Associated with ROS1-Rearranged Non-Small-Cell Lung Cancer. Clinical lung cancer Shah, A. T., Bernardo, R. J., Berry, G. J., Kudelko, K., Wakelee, H. A. 2020

  View details for DOI 10.1016/j.cllc.2020.09.020

  View details for PubMedID 33153897

• Updates in pulmonary hypertension and other pulmonary vascular diseases BREATHE Bernardo, R. J., Bokan, A., Ramjug, S. 2019; 15 (3): 241-243

  Abstract

  Update on studies related to pulmonary vascular disease published during 2018, addressing different topics in pulmonary hypertension, pulmonary embolism and chronic thromboembolic disease http://bit.ly/2JJUnUP.

  View details for DOI 10.1183/20734735.0187-2019

  View details for Web of Science ID 000484212800012

  View details for PubMedID 31508162

  View details for PubMedCentralID PMC6717623

• The pulmonary artery pulsatility index correlates with ventriculo-vascular coupling and elevated filling pressures in patients with pulmonary arterial hypertension. Bernardo, R., Vanderpool, R., Rischard, F. EUROPEAN RESPIRATORY SOC JOURNALS LTD. 2018

  View details for DOI 10.1183/13993003.congress-2018.PA3314

  View details for Web of Science ID 000455567104217