Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
Am J Respir Crit Care Med. 2011 Nov 15;184(10):1114-24. doi: 10.1164/rccm.201104-0662CI.
Despite advances in medical therapies, pulmonary arterial hypertension (PAH) continues to cause significant morbidity and mortality. Although the right ventricle (RV) can adapt to an increase in afterload, progression of the pulmonary vasculopathy that characterizes PAH causes many patients to develop progressive right ventricular failure. Furthermore, acute right ventricular decompensation may develop from disorders that lead to either an acute increase in cardiac demand, such as sepsis, or to an increase in ventricular afterload, including interruptions in medical therapy, arrhythmia, or pulmonary embolism. The poor reserve of the right ventricle, RV ischemia, and adverse right ventricular influence on left ventricular filling may lead to a global reduction in oxygen delivery and multiorgan failure. There is a paucity of data to guide clinicians caring for acute right heart failure in PAH. Treatment recommendations are frequently based on animal models of acute right heart failure or case series in humans with other causes of pulmonary hypertension. Successful treatment often requires that invasive hemodynamics be used to monitor the effect of strategies that are based primarily on biological plausibility. Herein we have developed an approach based on the current understanding of RV failure in PAH and have attempted to develop a treatment paradigm based on physiological principles and available evidence.
尽管医学治疗取得了进展，但肺动脉高压（PAH）仍然导致了显著的发病率和死亡率。尽管右心室（RV）可以适应后负荷的增加，但 PAH 特征性的肺血管病变的进展导致许多患者出现进行性右心衰竭。此外，急性右心室失代偿可能由导致心脏需求急性增加的疾病引起，如败血症，或由心室后负荷增加引起，包括中断药物治疗、心律失常或肺栓塞。右心室储备能力差、RV 缺血以及对左心室充盈的不利影响可能导致全身氧输送减少和多器官衰竭。目前的数据很少能够指导治疗急性右心衰竭的临床医生。治疗建议通常基于急性右心衰竭的动物模型或其他原因引起的肺动脉高压患者的病例系列。成功的治疗通常需要使用有创血流动力学监测主要基于生物学合理性的策略的效果。在此，我们根据目前对 PAH 中 RV 衰竭的理解制定了一种方法，并试图根据生理原理和现有证据制定一种治疗模式。
