Ramu Bhavadharini, Houston Brian A, Tedford Ryan J
Division of Cardiology, Department of Medicine, Medical University of South Carolina (MUSC), Strom Thurmond Gazes Building, Room 215, 114 Doughty St/MSC592, Charleston, SC, 29425, USA.
Curr Heart Fail Rep. 2018 Apr;15(2):81-93. doi: 10.1007/s11897-018-0377-9.
Pulmonary hypertension due to left heart disease (PH-LHD) is the most common cause of pulmonary hypertension worldwide, yet therapies used to treat pulmonary arterial hypertension have failed to show efficacy in this population. Proper hemodynamic assessment and differentiation of pulmonary hypertension phenotypes is therefore critical for both current clinical practice and future research and therapeutic efforts.
Substantial recent efforts have sought to improve the hemodynamic characterization of pulmonary hypertension for both diagnostic and prognostic purposes. These efforts include identifying occult LHD using provocative maneuvers as well as sub-classifying PH-LHD based on the presence or absence of a pre-capillary component. How to best define the pre-capillary component remains controversial as several studies have drawn conflicting conclusions. The lack of standardization of hemodynamic measurements as well as measurement fidelity concerns may explain some of the discrepant results. Non-hemodynamic methods of PH-LHD classification may also have an emerging role. Despite recent advances, therapeutic studies have largely remained disappointing. In this review, we discuss the nuances and controversies surrounding diagnostic and prognostic hemodynamic characterization of PH-LHD as well as summarize the recent therapeutic efforts and ongoing challenges in this population.
左心疾病所致肺动脉高压（PH-LHD）是全球肺动脉高压最常见的病因，但用于治疗肺动脉高压的疗法在该人群中未能显示出疗效。因此，正确的血流动力学评估和肺动脉高压表型的鉴别对于当前临床实践以及未来的研究和治疗工作都至关重要。
最近大量研究致力于改善肺动脉高压的血流动力学特征描述，以用于诊断和预后评估。这些努力包括使用激发试验识别隐匿性左心疾病，以及根据是否存在毛细血管前成分对PH-LHD进行亚分类。由于多项研究得出了相互矛盾的结论，如何最佳定义毛细血管前成分仍存在争议。血流动力学测量缺乏标准化以及测量准确性问题可能解释了一些不一致的结果。PH-LHD分类的非血流动力学方法可能也将发挥越来越重要的作用。尽管最近取得了进展，但治疗研究在很大程度上仍然令人失望。在本综述中，我们讨论了围绕PH-LHD诊断和预后血流动力学特征描述的细微差别和争议，并总结了该人群最近的治疗努力和持续面临的挑战。
