Division of Pulmonary, Lady Davis Carmel Medical Center, Faculty of Medicine, The Technion, Institute of Technology, Haifa, Israel.
Semin Respir Crit Care Med. 2013 Oct;34(5):665-80. doi: 10.1055/s-0033-1356490. Epub 2013 Sep 13.
Left heart disease (LHD) is probably the most frequent cause of pulmonary hypertension (PH). Although rheumatic mitral valve stenosis has been in the past the most common cause of this condition, PH-LHD mainly results from heart failure related to systolic and/or diastolic dysfunction of the left ventricle and is associated with elevated left-sided cardiac filling pressures. Most patients have passive increase in pulmonary arterial pressure because of backward transmission of the elevated left atrial pressure, whereas a small subset develop severe PH with elevated transpulmonary gradient and pulmonary vascular resistance. When present, PH is usually associated with a poor prognosis and increased mortality. Optimizing heart failure regimens and corrective valve surgery are the cornerstones of the treatment of PH in LHD. Although PH-LHD may evolve to right ventricular failure and is associated with some changes in the pulmonary vascular bed similar to pulmonary arterial hypertension (PAH), there is no evidence-based data to support the use of PAH-specific therapies in the setting of PH-LHD. However, recent studies suggest the usefulness of sildenafil, a phosphodiesterase-5 inhibitor. This review addresses the epidemiology, pathophysiology, risk factors, and treatment controversies of PH due to LHDs.
左心疾病（LHD）可能是肺动脉高压（PH）最常见的原因。尽管风湿性二尖瓣狭窄过去是这种情况的最常见原因，但 PH-LHD 主要是由于左心室收缩和/或舒张功能障碍引起的心衰所致，并且与升高的左侧心脏充盈压有关。大多数患者由于升高的左心房压力向后传递而导致肺动脉压被动升高，而一小部分患者则由于跨肺梯度和肺血管阻力升高而出现严重的 PH。当存在 PH 时，通常与预后不良和死亡率增加相关。优化心力衰竭方案和矫正瓣膜手术是 LHD 中 PH 治疗的基石。尽管 PH-LHD 可能进展为右心衰竭，并且与类似于肺动脉高压（PAH）的肺血管床的一些变化有关，但没有循证数据支持在 PH-LHD 中使用 PAH 特异性治疗。然而，最近的研究表明，磷酸二酯酶-5 抑制剂西地那非的使用具有一定作用。这篇综述讨论了由 LHD 引起的 PH 的流行病学、病理生理学、危险因素和治疗争议。
