University of Milano, University Cardiology Department, Policlinico San Donato, Milano, Italy; IRCCS, Policlinico San Donato, MIlano, Italy.
Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
J Am Coll Cardiol. 2020 Sep 1;76(9):1102-1111. doi: 10.1016/j.jacc.2020.06.069.
Pulmonary hypertension (PH) associated with left heart disease, or Group 2 PH, includes heart failure, valvular heart diseases, and congenital heart diseases. Although it is axiomatic that in PH due to heart failure the increase in pulmonary pressure is directly related to an enhanced left atrial pressure, which is common to both heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF), there has been limited attention over the years on the potential differences in terms of driving mechanisms, pathophysiology, and clinical phenotypes. Major differences between HFpEF and HFrEF are the underlying causes, associated comorbidities, and cardiac remodeling. This suggests that despite similar hemodynamic profiles, there may be some disparities in PH development. A focused knowledge on the differences between the 2 syndromes has relevant implications to seek new, personalized, and timely treatments for Group 2 PH. The purpose of the present review is to highlight the mechanisms and clinical phenotypes of PH in HFpEF and HFrEF.
与左心疾病相关的肺动脉高压（PH），或第 2 组 PH，包括心力衰竭、心脏瓣膜病和先天性心脏病。虽然心力衰竭引起的 PH 中肺压的增加与左心房压的增强直接相关是不言而喻的，这在射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）中都很常见，但多年来人们对驱动机制、病理生理学和临床表型方面的潜在差异关注有限。HFpEF 和 HFrEF 的主要区别在于潜在病因、相关合并症和心脏重构。这表明，尽管存在相似的血液动力学特征，但 PH 的发展可能存在一些差异。对这两种综合征之间差异的深入了解对于寻求第 2 组 PH 的新的、个性化和及时的治疗方法具有重要意义。本综述的目的是强调 HFpEF 和 HFrEF 中 PH 的机制和临床表型。
