Medical Intensive Care Unit, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA.
Am J Cardiol. 2012 Sep 15;110(6 Suppl):9S-15S. doi: 10.1016/j.amjcard.2012.06.011.
Right heart catheterization (RHC)-determined pulmonary hemodynamics are mandatory for the diagnosis and classification of pulmonary hypertension (PH) and can be used to assess response to PH-specific therapy and inform clinical decision-making. PH is diagnosed in patients with a mean pulmonary arterial pressure of ≥25 mm Hg at rest, with a further classification of pulmonary arterial hypertension (PAH) in patients with a pulmonary artery wedge pressure of ≤15 mm Hg and, often, reduced cardiac output. In addition, a number of hemodynamic variables, either measured directly with RHC or subsequently derived, have been shown to have prognostic significance in PAH, with different variables having more prognostic significance in specific patient populations. Although there is no hemodynamic definition of exercise-induced PAH, measurement of certain hemodynamic variables during exercise may identify an intermediary phenotype between healthy individuals and overt PAH at rest and may have prognostic implications. However, although exercise hemodynamics may be a closer reflection of the true resistive component of the pulmonary vasculature and its ability to respond to therapy, the lack of standardized protocols limits application in routine clinical practice.
右心导管检查（RHC）确定的肺血流动力学对于肺动脉高压（PH）的诊断和分类是必需的，可用于评估对 PH 特异性治疗的反应并为临床决策提供信息。PH 被诊断为静息时平均肺动脉压≥25mmHg，在肺动脉楔压≤15mmHg 且通常心输出量降低的患者中进一步分类为肺动脉高压（PAH）。此外，已经证明 RHC 直接测量或随后推导的许多血流动力学变量在 PAH 中具有预后意义，不同的变量在特定患者群体中具有更重要的预后意义。虽然运动性 PAH 没有血流动力学定义，但在运动过程中测量某些血流动力学变量可能会在健康个体和静息时明显 PAH 之间识别出一种中间表型，并且可能具有预后意义。然而，尽管运动血流动力学可能更接近肺血管的真实阻力成分及其对治疗的反应能力，但缺乏标准化方案限制了其在常规临床实践中的应用。
