Koulova Anna, Gass Alan L, Patibandla Saikrishna, Gupta Chhaya Aggarwal, Aronow Wilbert S, Lanier Gregg M
Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
Ross University School of Medicine, Miramar, FL, USA.
J Thorac Dis. 2017 Aug;9(8):2640-2649. doi: 10.21037/jtd.2017.07.24.
Pulmonary hypertension in left heart disease (PH-LHD) commonly complicates prolonged heart failure (HF). When advanced, the PH becomes fixed or out of proportion and is associated with increased morbidity and mortality in patients undergoing orthotopic heart transplant (OHT). To date, the only recommended treatment of out of proportion PH is the treatment of the underlying HF by reducing the pulmonary capillary wedge pressure (PCWP) with medications and often along with use of mechanical circulatory support. Medical therapies typically used in the treatment of World Health Organization (WHO) group 1 pulmonary arterial hypertension (PAH) have been employed off-label in the setting of PH-LHD with varying efficacy and often negative outcomes. We will discuss the current standard of care including treating HF and use of mechanical circulatory support. In addition, we will review the studies published to date assessing the efficacy and safety of PAH medications in patients with PH-LHD being considered for OHT.
左心疾病相关性肺动脉高压（PH-LHD）常使慢性心力衰竭（HF）病情复杂化。病情进展时，肺动脉高压会变得固定或不成比例，与接受原位心脏移植（OHT）患者的发病率和死亡率增加相关。迄今为止，对于不成比例的肺动脉高压，唯一推荐的治疗方法是通过使用药物降低肺毛细血管楔压（PCWP）来治疗潜在的心力衰竭，且通常还需联合使用机械循环支持。常用于治疗世界卫生组织（WHO）1组肺动脉高压（PAH）的药物已在PH-LHD患者中被超适应证使用，疗效各异且往往产生负面结果。我们将讨论当前的治疗标准，包括治疗心力衰竭和使用机械循环支持。此外，我们将回顾迄今为止发表的评估PAH药物在考虑接受OHT的PH-LHD患者中的疗效和安全性的研究。
