Rasmussen Jason T, Thenappan Thenappan, Benditt David G, Weir E Kenneth, Pritzker Marc R
Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Pulm Circ. 2014 Dec;4(4):552-9. doi: 10.1086/678470.
Pulmonary arterial hypertension is a manifestation of a group of disorders leading to pulmonary vascular remodeling and increased pulmonary pressures. The right ventricular (RV) response to chronic pressure overload consists of myocardial remodeling, which is in many ways similar to that seen in left ventricular (LV) failure. Maladaptive myocardial remodeling often leads to intraventricular and interventricular dyssychrony, an observation that has led to cardiac resynchronization therapy (CRT) for LV failure. CRT has proven to be an effective treatment strategy in subsets of patients with LV failure resulting in improvement in LV function, heart failure symptoms, and survival. Current therapy for pulmonary arterial hypertension is based on decreasing pulmonary vascular resistance, and there is currently no effective therapy targeting the right ventricle or maladaptive ventricular remodeling in these patients. This review focuses on the RV response to chronic pressure overload, its effect on electromechanical coupling and synchrony, and how lessons learned from left ventricular cardiac resynchronization might be applied as therapy for RV dysfunction in the context of pulmonary arterial hypertension.
肺动脉高压是一组导致肺血管重塑和肺压力升高的疾病的表现。右心室（RV）对慢性压力超负荷的反应包括心肌重塑，这在许多方面与左心室（LV）衰竭时所见相似。适应性不良的心肌重塑常导致心室内和心室间不同步，这一观察结果促使了针对左心室衰竭的心脏再同步治疗（CRT）。CRT已被证明是左心室衰竭患者亚组中的一种有效治疗策略，可改善左心室功能、心力衰竭症状和生存率。目前肺动脉高压的治疗基于降低肺血管阻力，目前尚无针对这些患者右心室或适应性不良心室重塑的有效治疗方法。本综述重点关注右心室对慢性压力超负荷的反应、其对机电耦合和同步性的影响，以及从左心室心脏再同步治疗中学到的经验教训如何应用于肺动脉高压背景下右心室功能障碍的治疗。
