Cardiology Department, Kantonsspital St. Gallen, Switzerland.
Cardiology Department, Kantonsspital St. Gallen, Switzerland.
Trends Cardiovasc Med. 2022 Feb;32(2):73-81. doi: 10.1016/j.tcm.2020.12.005. Epub 2020 Dec 17.
In patients with severe aortic stenosis (AS), pulmonary hypertension (PH) typically is indicative of a decompensated disease state with exhausted compensatory mechanisms of the left ventricle, meaning a heart failure state resulting from AS-related "cardiac injury". In the present review article, we discuss new insights into the pathophysiology of AS-induced PH, the prognostic impact, and potential options to prevent and treat PH in this setting. We emphasize recent data from studies focused on invasive hemodynamics in patients with severe AS that are being evaluated for aortic valve replacement, particularly the key relevance of combined pre- and post-capillary PH. This latter represents an advanced form of cardiac injury that is often associated with right ventricular dysfunction and poor prognosis. Given this context, we highlight the relevance of performing right heart catheterization in combination with non-invasive imaging for the comprehensive assessment of AS patients that are being evaluated for aortic valve replacement. Such comprehensive assessment plays a key role not only to precisely define the extent of AS-related cardiac injury but also to distinguish those PH forms that are unrelated to AS.
在严重主动脉瓣狭窄（AS）患者中，肺动脉高压（PH）通常表明左心室代偿机制已耗尽，疾病状态失代偿，即 AS 相关“心脏损伤”导致的心力衰竭状态。在本综述文章中，我们讨论了 AS 引起的 PH 的病理生理学、预后影响以及在这种情况下预防和治疗 PH 的潜在选择的新见解。我们强调了最近来自专注于严重 AS 患者有创血液动力学研究的数据，这些研究正在评估主动脉瓣置换，特别是联合毛细血管前和毛细血管后 PH 的关键相关性。后者代表了一种更高级形式的心脏损伤，通常与右心室功能障碍和预后不良有关。鉴于这种情况，我们强调了在评估主动脉瓣置换的 AS 患者中进行右心导管检查与非侵入性成像相结合的重要性，以进行综合评估。这种综合评估不仅对于精确定义 AS 相关心脏损伤的程度，而且对于区分与 AS 无关的 PH 形式都起着关键作用。
