Rao Sriram D, Menachem Jonathan N, Birati Edo Y, Mazurek Jeremy A
Advanced Heart Failure/Transplantation Program, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Advanced Heart Failure and Cardiac Transplant Program, Advanced Congenital Cardiac Therapies, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Curr Heart Fail Rep. 2019 Oct;16(5):119-129. doi: 10.1007/s11897-019-00431-4.
In patients with heart failure with reduced ejection fraction, the presence of pulmonary hypertension (PH-LHD) has a significant impact on their prognosis. The purpose of this review is to explain the methods of diagnosing PH-LHD and then discuss the available therapeutic options.
We begin by examining the methods of assessment of PH-LHD-echocardiography, cardiopulmonary exercise testing, and right heart catheterization-with a particular focus on the importance of accurate measurement to ensure the proper determination of PH-LHD. We then focus primarily on management of PH-LHD, with an examination of trials of therapeutic options, use of mechanical circulatory support, and transplantation. This review highlights the complexities in diagnosis and management of PH-LHD. We outline a number of useful ways to maximize the yield of diagnostic testing, as well as give suggestions on the use of medical therapies, the role of both temporary mechanical support and left ventricular assist device, and finally the ways to best bridge these patients to transplantation.
在射血分数降低的心力衰竭患者中，肺动脉高压（左心疾病相关性肺动脉高压，PH-LHD）的存在对其预后有重大影响。本综述的目的是解释诊断PH-LHD的方法，然后讨论现有的治疗选择。
我们首先研究PH-LHD的评估方法——超声心动图、心肺运动试验和右心导管检查——特别关注准确测量对于确保正确诊断PH-LHD的重要性。然后我们主要关注PH-LHD的管理，审查治疗选择的试验、机械循环支持的使用和移植情况。本综述强调了PH-LHD诊断和管理中的复杂性。我们概述了一些提高诊断测试效率的有用方法，并就药物治疗的使用、临时机械支持和左心室辅助装置的作用提出建议，最后还介绍了将这些患者最佳过渡到移植的方法。
