Rosenkranz S, Kramer T, Gerhardt F, Opitz C, Olsson K M, Hoeper M M
Klinik III für Innere Medizin und Cologne Cardiovascular Research Center (CCRC), Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Cologne, Germany.
Klinik für Innere Medizin, Schwerpunkt Kardiologie, DRK-Kliniken Berlin, Berlin, Germany.
Herz. 2019 Sep;44(6):483-490. doi: 10.1007/s00059-019-4831-6.
Pulmonary hypertension (PH) is a frequent hemodynamic condition that is highly prevalent in patients with heart failure and reduced (HFrEF) or preserved ejection fraction (HFpEF). Irrespective of left ventricular EF, the presence of PH and right ventricular (RV) dysfunction are highly relevant for morbidity and mortality in patients with heart failure. While elevated left-sided filling pressures and functional mitral regurgitation primarily lead to post-capillary PH, current guidelines and recommendations distinguish between isolated post-capillary PH (IpcPH) and combined post- and pre-capillary PH (CpcPH), the latter being defined by a pulmonary vascular resistance (PVR) of ≥3 Wood units. Here, we describe the pathophysiology and clinical relevance of these distinct entities, and report on the diagnostic work-up including remote pulmonary artery pressure (PAP) monitoring. Furthermore, we highlight strategies to manage PH and improve RV function in heart failure, which may include optimized management of HFrEF and HFpEF (medical and interventional), sufficient volume control, catheter-based mitral valve repair, and-in selected cases-targeted PH therapy. In this context, we also highlight gaps in evidence and the need for further research.
肺动脉高压（PH）是一种常见的血流动力学状态，在射血分数降低（HFrEF）或保留（HFpEF）的心力衰竭患者中高度流行。无论左心室射血分数如何，PH的存在和右心室（RV）功能障碍与心力衰竭患者的发病率和死亡率高度相关。虽然左侧充盈压升高和功能性二尖瓣反流主要导致毛细血管后PH，但当前的指南和建议区分了孤立性毛细血管后PH（IpcPH）和毛细血管后与毛细血管前联合PH（CpcPH），后者定义为肺血管阻力（PVR）≥3伍德单位。在此，我们描述了这些不同实体的病理生理学和临床相关性，并报告了包括远程肺动脉压（PAP）监测在内的诊断检查。此外，我们强调了在心力衰竭中管理PH和改善RV功能的策略，这可能包括优化HFrEF和HFpEF的管理（药物和介入治疗）、充分的容量控制、基于导管的二尖瓣修复，以及在某些情况下进行有针对性的PH治疗。在此背景下，我们还强调了证据方面的差距以及进一步研究的必要性。
