Pulmonary Vascular Disease Program, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Florida, Gainesville, Florida, USA.
Respir Med. 2010 Apr;104(4):481-96. doi: 10.1016/j.rmed.2009.11.015. Epub 2009 Dec 8.
Pulmonary arterial hypertension (PAH) encompasses a number of diseases responsible for a specific set of hemodynamic findings during right heart catheterization. During initial workup, pulmonary vasodilator testing is performed. A positive acute pulmonary vasodilator test predicts better survival and response to calcium channel blocker (CCB) therapy. There is lack of consensus on the preferred agent for determining acute pulmonary vasoreactivity. The ACCP guidelines and the 4(th) World Symposium on Pulmonary Hypertension support the use of intravenous epoprostenol or nitric oxide (NO) as the preferred agents for pulmonary vasodilator testing. A decrease in the mean pulmonary artery pressure by at least 10 mmHg to reach an absolute value of 40 mmHg or less without a decrease in cardiac output is currently considered a positive pulmonary vasodilator test. A positive test by the current recommended criteria is observed in about 10-15% of patients with idiopathic PAH. Approximately half of these patients will experience long-term benefits with CCBs. A positive test may select patients with an earlier or less aggressive form of disease, which may carry a better prognosis. A positive vasodilator test is observed very infrequently in patients with pulmonary arterial hypertension other than idiopathic PAH or anorexigen associated PAH. This article reviews the literature regarding pulmonary vasodilator testing and use of CCB therapy in patients with PAH, while identifying the gaps in knowledge concerning this diagnostic procedure.
肺动脉高压（PAH）包含多种疾病，这些疾病在右心导管检查期间导致特定的一组血流动力学发现。在初始检查期间，进行肺血管扩张剂测试。急性肺血管扩张剂测试阳性预测生存和钙通道阻滞剂（CCB）治疗反应更好。对于确定急性肺血管反应性的首选药物，缺乏共识。ACCP 指南和第 4 届世界肺动脉高压研讨会支持使用静脉内依前列醇或一氧化氮（NO）作为肺血管扩张剂测试的首选药物。目前认为，平均肺动脉压至少降低 10mmHg，达到绝对值 40mmHg 或更低，而心输出量没有降低，是阳性肺血管扩张剂测试。根据目前推荐的标准，约 10-15%的特发性 PAH 患者出现阳性测试。这些患者中约有一半将长期受益于 CCB。阳性测试可能选择疾病早期或侵袭性较弱的患者，这些患者预后可能更好。在除特发性 PAH 或与厌食药相关的 PAH 以外的肺动脉高压患者中，阳性血管扩张剂测试非常罕见。本文回顾了关于 PAH 患者肺血管扩张剂测试和 CCB 治疗的文献，同时确定了该诊断程序相关知识的空白。
