Ovchinnikov Artem, Potekhina Alexandra, Belyavskiy Evgeny, Ageev Fail
Out-Patient Department, Institute of Clinical Cardiology, National Medical Research Center of Cardiology Named after Academician E.I. Chazov, 3-d Cherepkovskaya St., 15a, 121552 Moscow, Russia.
Department of Clinical Functional Diagnostics, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Delegatskaya St., 20, p. 1, 127473 Moscow, Russia.
Pharmaceuticals (Basel). 2022 Aug 19;15(8):1024. doi: 10.3390/ph15081024.
Pulmonary hypertension (PH) is common in patients with heart failure with preserved ejection fraction (HFpEF). A chronic increase in mean left atrial pressure leads to passive remodeling in pulmonary veins and capillaries and modest PH (isolated postcapillary PH, Ipc-PH) and is not associated with significant right ventricular dysfunction. In approximately 20% of patients with HFpEF, "precapillary" alterations of pulmonary vasculature occur with the development of the combined pre- and post-capillary PH (Cpc-PH), pertaining to a poor prognosis. Current data indicate that pulmonary vasculopathy may be at least partially reversible and thus serves as a therapeutic target in HFpEF. Pulmonary vascular targeted therapies, including phosphodiesterase (PDE) inhibitors, may have a valuable role in the management of patients with PH-HFpEF. In studies of Cpc-PH and HFpEF, PDE type 5 inhibitors were effective in long-term follow-up, decreasing pulmonary artery pressure and improving RV contractility, whereas studies of Ipc-PH did not show any benefit. Randomized trials are essential to elucidate the actual value of PDE inhibition in selected patients with PH-HFpEF, especially in those with invasively confirmed Cpc-PH who are most likely to benefit from such treatment.
肺动脉高压（PH）在射血分数保留的心力衰竭（HFpEF）患者中很常见。平均左心房压力的慢性升高会导致肺静脉和毛细血管的被动重塑以及轻度肺动脉高压（单纯毛细血管后肺动脉高压，Ipc-PH），且与明显的右心室功能障碍无关。在大约20%的HFpEF患者中，随着毛细血管前和毛细血管后联合肺动脉高压（Cpc-PH）的发展，会出现肺血管的“毛细血管前”改变，这与预后不良有关。目前的数据表明，肺血管病变可能至少部分是可逆的，因此可作为HFpEF的治疗靶点。包括磷酸二酯酶（PDE）抑制剂在内的肺血管靶向治疗可能在PH-HFpEF患者的管理中发挥重要作用。在Cpc-PH和HFpEF的研究中，5型PDE抑制剂在长期随访中有效，可降低肺动脉压力并改善右心室收缩力，而Ipc-PH的研究未显示任何益处。随机试验对于阐明PDE抑制在选定的PH-HFpEF患者中的实际价值至关重要，尤其是在那些经侵入性证实为Cpc-PH且最有可能从此类治疗中获益的患者中。
