Cardiovascular Institute Allegheny Health Network Pittsburgh PA.
Department of Medicine Medical University of South Carolina Charleston SC.
J Am Heart Assoc. 2021 Apr 6;10(7):e017684. doi: 10.1161/JAHA.120.017684. Epub 2021 Mar 15.
An elevated right ventricular/pulmonary artery systolic pressure suggestive of pulmonary hypertension (PH) is a common finding noted on echocardiography and is considered a marker for poor clinical outcomes, regardless of the cause. Even mild elevation of pulmonary pressure can be considered a modifiable risk factor, informing the trajectory of patients' clinical outcome. Although guidelines have been published detailing diagnostic and management algorithms, this echocardiographic finding is often underappreciated or not acted upon. Hence, patients with PH are often diagnosed in clinical practice when hemodynamic abnormalities are already moderate or severe. This results in delayed initiation of potentially effective therapies, referral to PH centers, and greater patient morbidity and mortality. This mini-review presents a succinct, simplified case-based approach to the "next steps" in the work-up of PH, once elevated pulmonary pressures have been noted on an echocardiogram. Our goal is for clinicians to develop a good overview of diagnostic approach to PH and recognition of high-risk features that may require early referral.
超声心动图检查发现右心室/肺动脉收缩压升高提示肺动脉高压（PH），这是一种常见表现，与病因无关，被认为是临床预后不良的标志物。即使肺动脉压轻度升高也被认为是一个可改变的危险因素，影响患者的临床预后轨迹。尽管已经发布了详细的诊断和管理算法指南，但该超声心动图发现往往被低估或未被重视。因此，PH 患者在临床实践中通常在血流动力学异常已经中度或重度时才被诊断。这导致潜在有效治疗的起始延迟、PH 中心的转诊以及患者发病率和死亡率的增加。本篇迷你综述提供了一种简洁、简化的基于病例的方法，介绍了在超声心动图检查发现肺动脉压升高后的 PH 检查的“下一步”。我们的目标是让临床医生对 PH 的诊断方法有一个很好的了解，并认识到可能需要早期转诊的高危特征。
