Clinic III for Internal Medicine, Heart Center at the University of Cologne.
Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany.
Curr Opin Cardiol. 2020 Nov;35(6):610-619. doi: 10.1097/HCO.0000000000000791.
Pulmonary hypertension is a common phenomenon in heart failure patients that is highly relevant for morbidity and outcome. Although postcapillary in nature, the pathophysiology of pulmonary hypertension in patients with heart failure with reduced or preserved ejection fraction is complex, and decisions about management strategies remain challenging.
Recently, the hemodynamic definitions and subclassification of postcapillary pulmonary hypertension have been revisited. The distinction between isolated postcapillary pulmonary hypertension (IpcPH) and combined post and precapillary pulmonary hypertension (CpcPH) and their definition are essential. Novel data on the prognostic impact of hemodynamic variables and right ventricular function highlight the importance of cardiopulmonary interaction in patients with left-sided heart failure (LHF). Furthermore, the impact of management strategies including medical therapy, remote hemodynamic monitoring, and interventional approaches on hemodynamics and outcome has recently been investigated. Here, we critically review recent developments and future considerations in this field, and highlight distinct treatment strategies targeting the underlying left heart condition, the pulmonary circulation, and/or impaired right ventricular function.
Detailed hemodynamic characterization and proper phenotyping are essential for prognostication and the management of patients with pulmonary hypertension associated with LHF, both in clinical practice and when addressing research questions.
肺动脉高压是心力衰竭患者的一种常见现象，与发病率和预后密切相关。尽管本质上是毛细血管后病变，但射血分数降低或保留的心力衰竭患者的肺动脉高压病理生理学较为复杂，管理策略的决策仍然具有挑战性。
最近，毛细血管后肺动脉高压的血流动力学定义和亚分类已经重新审视。孤立性毛细血管后肺动脉高压（IpcPH）和合并毛细血管后和前毛细血管肺动脉高压（CpcPH）的区分及其定义至关重要。血流动力学变量和右心室功能的预后影响的新数据突出了左心衰竭（LHF）患者中心肺相互作用的重要性。此外，最近还研究了包括药物治疗、远程血流动力学监测和介入方法在内的管理策略对血流动力学和预后的影响。在此，我们批判性地回顾了该领域的最新进展和未来考虑因素，并强调了针对潜在左心疾病、肺循环和/或受损右心室功能的不同治疗策略。
详细的血流动力学特征描述和恰当的表型分析对于预测和管理与 LHF 相关的肺动脉高压至关重要，无论是在临床实践中还是在解决研究问题时都是如此。
