Rosenkranz Stephan
Klinik III für Innere Medizin (Kardiologie), Zentrum für Molekulare Medizin Köln (ZMMK), Cologne Cardiovascular Research Center (CCRC), Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
Herz. 2023 Feb;48(1):23-30. doi: 10.1007/s00059-022-05155-1. Epub 2023 Jan 17.
Pulmonary hypertension (PH) is a hemodynamic state that can be caused by a variety of underlying conditions. The pathophysiology is complex and can involve several organ systems, requiring a multidisciplinary approach to differential diagnostics and management. This review article provides a comprehensive overview of the most important changes in the updated 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines on the diagnostics and treatment of pulmonary hypertension, as compared to the previous 2015 version. A special focus is on (i) updated hemodynamic definitions of PH, including general definition, precapillary vs. postcapillary PH, isolated postcapillary PH (IpcPH), combined postcapillary and precapillary PH (CpcPH), (ii) the clinical presentation and classification of PH, (iii) the diagnostic approach as well as (iv) specific aspects of pulmonary arterial hypertension (PAH, group 1), including risk assessment, treatment and PAH with comorbidities, PH associated with left heart (group 2) or lung disease (group 3), and chronic thromboembolic pulmonary hypertension (CTEPH, group 4). Regarding the latter, the specific diagnostic algorithm and the multimodal approach to treatment are presented. Finally, for each of the PH groups, clinically relevant aspects and innovations are briefly and concisely presented.
肺动脉高压(PH)是一种血流动力学状态,可由多种潜在疾病引起。其病理生理学复杂,可涉及多个器官系统,需要采用多学科方法进行鉴别诊断和管理。与2015年的上一版指南相比,本文综述了2022年欧洲心脏病学会(ESC)/欧洲呼吸学会(ERS)肺动脉高压诊断和治疗指南中最重要的变化。特别关注的内容包括:(i)PH的血流动力学定义更新,包括一般定义、毛细血管前性与毛细血管后性PH、孤立性毛细血管后性PH(IpcPH)、毛细血管后性与毛细血管前性联合PH(CpcPH);(ii)PH的临床表现和分类;(iii)诊断方法;以及(iv)肺动脉高压(PAH,第1组)的具体方面,包括风险评估、治疗以及合并症的PAH、与左心相关的PH(第2组)或肺部疾病相关的PH(第3组),还有慢性血栓栓塞性肺动脉高压(CTEPH,第4组)。对于后者,介绍了具体的诊断算法和多模式治疗方法。最后,对每个PH组的临床相关方面和创新内容进行了简要而精炼的阐述。