Kalogeropoulos Andreas P, Vega J David, Smith Andrew L, Georgiopoulou Vasiliki V
Emory Clinical Cardiovascular Research Institute, Atlanta, GA, USA.
Congest Heart Fail. 2011 Jul-Aug;17(4):189-98. doi: 10.1111/j.1751-7133.2011.00234.x. Epub 2011 Jul 21.
Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are frequently encountered in patients with advanced heart failure (HF). Both conditions aggravate prognosis and influence clinical decisions. Echocardiography is the screening tool of choice for pulmonary pressures and RV function, although invasive assessment of PH is necessary when advanced therapies are considered. Reversibility of PH in response to short-term pharmacologic treatment or even to long-term unloading after left ventricular assist device (LVAD) implantation is a favorable prognostic sign for both medically treated patients and heart transplant candidates. Although patients with severe PH secondary to HF have not derived benefit from pulmonary arterial hypertension therapies thus far, agents that modulate the cyclic guanosine monophosphate pathway, including phosphodiesterase 5A inhibitors, hold promise and are being actively investigated in advanced HF. Therapies that lead to reduction in left-sided pressures, including cardiac resynchronization and LVAD placement, also have a favorable effect on pulmonary pressures and RV function. However, no specific medical treatment for RV dysfunction exists to date, highlighting an important gap in the management of patients with advanced HF.
肺动脉高压（PH）和右心室（RV）功能障碍在晚期心力衰竭（HF）患者中经常出现。这两种情况都会使预后恶化并影响临床决策。超声心动图是评估肺动脉压力和右心室功能的首选筛查工具，不过在考虑采用先进治疗方法时，有必要对肺动脉高压进行侵入性评估。对于接受药物治疗的患者和心脏移植候选者而言，短期药物治疗甚至左心室辅助装置（LVAD）植入后的长期负荷减轻所引起的肺动脉高压可逆性是一个良好的预后指标。尽管迄今为止，继发于心力衰竭的重度肺动脉高压患者尚未从肺动脉高压治疗中获益，但包括磷酸二酯酶5A抑制剂在内的调节环磷酸鸟苷途径的药物有望取得疗效，目前正在晚期心力衰竭患者中积极开展研究。包括心脏再同步化治疗和左心室辅助装置植入在内的能够降低左心压力的治疗方法，对肺动脉压力和右心室功能也有积极影响。然而，迄今为止尚无针对右心室功能障碍的特异性药物治疗方法，这凸显了晚期心力衰竭患者管理方面的一个重要空白。
