4th IPVD Symposium in Rio de Janeiro, Brazil: Embracing Heterogeneity

The 4th iPVD Symposium took place on January 29th during the 2025 PVRI Annual World Congress on PVD, held in Rio de Janeiro (Congress Program). Researchers and clinicians presented ground-breaking findings and had productive, lively discussions. Below are some of the highlights from our Symposium.

Panel discussions on schistosomiasis

  1. Diagnostic Complexity: Differentiating schistosomiasis-PAH from idiopathic PAH remains difficult—especially in endemic settings—requiring liver imaging, portal hypertension markers, and serology.

  2. Persistent Disease Despite Treatment: Even after praziquantel and regression of hepatic fibrosis, PAH may persist due to irreversible vascular remodeling.

  3. Pathogenesis & Risk: Disease arises from interplay between egg burden, Th2-driven inflammation, and host genetics; males may be more affected due to exposure patterns.

  4. Epidemiology & Screening Gaps: Cases now often appear years after migration from endemic areas; limited screening and low clinical awareness delay diagnosis.

  5. Future Priorities: Develop biomarkers, expand routine echocardiographic and antigen-based screening, and strengthen multidisciplinary and public health approaches.

Schistosomiasis associated PVD in Latin America

  1. Epidemiology and Clinical Profile: Schistosomiasis-associated PAH (Sch-PAH) remains a major cause of pulmonary hypertension in Brazil, particularly in Bahia and Minas Gerais, often affecting middle-aged women who present with advanced disease but show similar hemodynamics and treatment response to idiopathic PAH

  2. Diagnostic and Public Health Challenges: Differentiating Sch-PAH from idiopathic PAH is difficult—many patients lack active infection or egg detection—and underdiagnosis persists due to limited screening, infrastructure, and physician awareness in endemic and rural areas.

  3. Referral Bias and Disease Spectrum: Current data reflect patients referred to tertiary centers with advanced disease, suggesting a larger pool of undiagnosed, milder cases in the community that remain outside clinical studies.

  4. Pathobiologic Convergence: Among advanced cases, progression and survival mirror idiopathic PAH, supporting the idea that once endothelial injury becomes self-sustaining, the original infectious trigger may no longer determine disease behavior.

  5. Research and Collaboration Needs Unified Brazilian registries, prospective studies, and omics-based investigations are needed to clarify shared mechanisms with idiopathic PAH and guide tailored therapies through national and international collaboration.