Karyofyllis Panagiotis, Demerouti Eftychia, Habibis Pavlos, Apostolopoulou Styliani, Tsetika Eleftheria-Garyfallia, Tsiapras Dimitrios
Cardiology Department, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
School of Medicine, University of Thessaly, 41221 Larissa, Greece.
Life (Basel). 2023 May 17;13(5):1202. doi: 10.3390/life13051202.
Despite the evolution of drug therapy in pulmonary arterial hypertension and the more aggressive treatment approach according to the guidelines, patients continue to have unacceptable mortality rates. Furthermore, specific drug therapy alone in chronic thromboembolic pulmonary hypertension also does not seem to have any beneficial impact on survival. As the function of the right ventricle (RV) determines the prognosis of patients with pulmonary hypertension, the treatment strategy should focus on modifying factors involved in RV dysfunction. Although some previous reports demonstrated that the survival of patients with pulmonary hypertension was associated with mPAP, nevertheless, mPAP is still not considered as a target of therapy. There are many examples of effective mPAP lowering with early and aggressive drug therapy in pulmonary arterial hypertension, or with interventions in chronic thromboembolic pulmonary hypertension. This effective mPAP reduction can lead to reverse RV remodeling, and thus, improvement in survival. In this article, the importance of mPAP lowering is stated, as well as why the change of our current strategy and considering mPAP reduction as the target of therapy could make pulmonary hypertension a chronic but not fatal disease.
尽管肺动脉高压的药物治疗有所进展，且遵循指南采取了更积极的治疗方法，但患者的死亡率仍然高得令人难以接受。此外，单独使用特定药物治疗慢性血栓栓塞性肺动脉高压似乎对生存率也没有任何有益影响。由于右心室（RV）的功能决定了肺动脉高压患者的预后，治疗策略应侧重于改善与右心室功能障碍有关的因素。尽管之前的一些报告表明肺动脉高压患者的生存率与平均肺动脉压（mPAP）有关，但mPAP仍未被视为治疗靶点。在肺动脉高压中，通过早期积极的药物治疗，或在慢性血栓栓塞性肺动脉高压中通过干预措施有效降低mPAP的例子有很多。这种有效的mPAP降低可导致右心室重塑逆转，从而提高生存率。在本文中，阐述了降低mPAP的重要性，以及为何改变我们目前的策略并将降低mPAP作为治疗靶点可使肺动脉高压成为一种慢性但非致命性疾病。
