The Importance of Detecting Pulmonary Hypertension

The main findings from this study at the moment are to sort of highlight the fact that pulmonary hypertension almost certainly is developing as you say over a number of years. There's a tipping point of which becomes hemodynamically significant and that again maybe that is another point why it is important to be thinking about hemodynamically making a diagnosis earlier. How do you see this data translating into clinical care more generally I know we can't get away with talking about scleroderma pulmonary hypertension without discussing detect, so how does a clinician for example utilize this analysis?