Cardiopulmonary Unit, University of Milan, San Paolo Hospital, Via A. di Rudinì 8, 20142 Milan, Italy.
Nat Rev Cardiol. 2010 Nov;7(11):648-59. doi: 10.1038/nrcardio.2010.144. Epub 2010 Oct 5.
Pulmonary hypertension (PH) with left-sided heart disease is defined, according to the latest Venice classification, as a Group 2 PH, which includes left-sided ventricular or atrial disease, and left-sided valvular diseases. These conditions are all associated with increased left ventricular filling pressure. Although PH with left-sided heart disease is a common entity, and long-term follow-up trials have provided firm recognition that development of left-sided PH carries a poor outcome, available data on incidence, pathophysiology, and therapy are sparse. Mitral stenosis was reported as the most frequent cause of PH several decades ago, but PH with left-sided heart disease is now usually caused by systemic hypertension and ischemic heart disease. In patients with these conditions, PH develops as a consequence of impaired left ventricular relaxation and distensibility. Chronic sustained elevation of cardiogenic blood pressure in pulmonary capillaries leads to a cascade of untoward retrograde anatomical and functional effects that represent specific targets for therapeutic intervention. The pathophysiological and clinical importance of the hemodynamic consequences of left-sided heart disease, starting with lung capillary injury and leading to right ventricular overload and failure, are discussed in this Review, focusing on PH as an evolving contributor to heart failure that may be amenable to novel interventions.
左心疾病相关肺动脉高压（PH）根据最新的威尼斯分类被定义为 2 型 PH，包括左心室或心房疾病以及左心瓣膜疾病。这些情况均与左心室充盈压升高相关。尽管左心疾病相关 PH 较为常见，且长期随访试验明确了左心 PH 进展与不良预后相关，但目前有关其发病率、病理生理学和治疗的数据仍然有限。数十年前曾报道二尖瓣狭窄是 PH 的最常见病因，但现在左心疾病相关 PH 通常由系统性高血压和缺血性心脏病引起。在这些情况下，PH 的发生是由于左心室舒张和顺应性受损所致。心源性血压在肺毛细血管中持续慢性升高，导致一系列不利的逆行解剖和功能效应，这些效应代表了治疗干预的特定靶点。本文综述了左心疾病血流动力学后果的病理生理学和临床重要性，从肺毛细血管损伤开始，导致右心室负荷过重和衰竭，并重点讨论了 PH 作为心力衰竭的一种进展性病因，可能适合新的干预措施。
