Kempton Hannah, Hungerford Sara, Muller David W, Hayward Christopher S
Department of Cardiology, St Vincent's Hospital, Sydney, Australia.
Faculty of Health and Medicine, The University of New South Wales, Sydney, Australia.
Int J Cardiol Heart Vasc. 2024 Jul 26;53:101472. doi: 10.1016/j.ijcha.2024.101472. eCollection 2024 Aug.
Pulmonary hypertension (PH) is a common and prognostically important complication of mitral regurgitation (MR). Mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) are traditionally used to diagnose PH, however these indices measure static rather than pulsatile load, leading to an incomplete representation of pulmonary vascular load on the right ventricle (RV). Pulmonary arterial compliance (PAC) is one method for quantifying pulsatile load, and is both a stronger predictor of prognosis in left heart failure, as well as a more sensitive measure of early pulmonary vascular dysfunction than PVR. With the expansion of transcatheter mitral and tricuspid valve therapies, there is renewed interest to more accurately define the load imposed by the pulmonary vasculature on the RV, especially in the early phase, prior to the onset of chronic PH. This review discusses the pathophysiology of pH in left heart failure and MR, the utility of PAC as a measure of RV afterload, and its calculation for clinical use and interpretation, underlining the utility of PAC as an adjunct for assessing pulmonary vascular haemodynamics.
肺动脉高压（PH）是二尖瓣反流（MR）常见且对预后有重要影响的并发症。传统上，平均肺动脉压（mPAP）和肺血管阻力（PVR）用于诊断PH，但这些指标测量的是静态而非搏动性负荷，导致对右心室（RV）肺血管负荷的描述不完整。肺动脉顺应性（PAC）是量化搏动性负荷的一种方法，它不仅是左心衰竭预后更强的预测指标，也是比PVR更敏感的早期肺血管功能障碍指标。随着经导管二尖瓣和三尖瓣治疗的扩展，人们重新关注更准确地界定肺血管系统对RV施加的负荷，尤其是在慢性PH发作之前的早期阶段。本综述讨论了左心衰竭和MR中PH的病理生理学、PAC作为RV后负荷测量指标的效用及其临床应用和解读的计算方法，强调了PAC作为评估肺血管血流动力学辅助手段的效用。
