Naing Pyi, Kuppusamy Harveen, Scalia Gregory, Hillis Graham S, Playford David
University of Notre Dame Australia, Fremantle, WA, Australia; Mount Hospital, Perth, WA, Australia.
University of Notre Dame Australia, Fremantle, WA, Australia; Mount Hospital, Perth, WA, Australia.
Heart Lung Circ. 2017 Apr;26(4):323-330. doi: 10.1016/j.hlc.2016.10.008. Epub 2016 Nov 20.
Pulmonary Hypertension (PHT) is relatively common, dangerous and under-recognised. Pulmonary hypertension is not a diagnosis in itself; it is caused by a number of differing diseases each with different treatments and prognoses. Therefore, timely and accurate recognition of the underlying cause for PHT is essential for appropriate management. This is especially true for patients with Pulmonary Arterial Hypertension (PAH) in the current era of disease-specific drug therapy. Measurement of Pulmonary Vascular Resistance (PVR) helps separate pre-capillary from post-capillary PHT, and is measured with right heart catheterisation (RHC). Echocardiography has been used to derive a number of non-invasive surrogates for PVR, with varying accuracy. Ultimately, the goal of non-invasive assessment of PVR is to separate PHT due to left heart disease from PHT due to increased PVR, to help streamline investigation and subsequent treatment. In this review, we summarise the physiology and pathophysiology of pulmonary blood flow, the various causes of pulmonary hypertension, and non-invasive surrogates for PVR.
肺动脉高压（PHT）相对常见、危险且未得到充分认识。肺动脉高压本身并非一种诊断；它由多种不同疾病引起，每种疾病的治疗方法和预后各不相同。因此，及时准确地识别肺动脉高压的潜在病因对于恰当的管理至关重要。在当前针对特定疾病的药物治疗时代，对于肺动脉高压（PAH）患者而言尤其如此。肺血管阻力（PVR）的测量有助于区分毛细血管前性与毛细血管后性肺动脉高压，且通过右心导管检查（RHC）进行测量。超声心动图已被用于得出多种用于评估肺血管阻力的非侵入性替代指标，其准确性各异。最终，肺血管阻力非侵入性评估的目标是将因左心疾病导致的肺动脉高压与因肺血管阻力增加导致的肺动脉高压区分开来，以帮助简化检查及后续治疗。在本综述中，我们总结了肺血流的生理和病理生理学、肺动脉高压的各种病因以及肺血管阻力的非侵入性替代指标。
