在患有左心病的患者中诊断毛细血管后高血压:新指南的影响
Gülmisal Güder1,2, Theresa Reiter3, Georg Fette4,5
1Department of Internal Medicine I, Cardiology Division, University Hospital Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany. gueder_g@ukw.de.
概括
2022年ESC/ERS关于左心病肺高血压的指导方针增加了结合的毛细血管前后PH诊断. 这一转变是由于重新分类无法分类的病例,并将患者从孤立的毛细血管后PH移动.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 医疗成像医学成像
背景情况:
- 2022年欧洲心脏病学会/欧洲呼吸学会 (ESC/ERS) 的指导方针更新了左心病中肺高血压 (PH) 的定义.
- 这种新定义对毛细血管后PH (pc-PH) 患病率及其子组的影响仍然不清楚.
研究的目的:
- 评估新的ESC/ERS 2022定义对PC-PH及其子组 (隔离后毛细血管PH[Ipc-PH]和联合前后毛细血管PH[Cpc-PH]) 在患有心脏左侧疾病的患者中患病率的影响.
- 根据2015年和2022年ESC/ERS指南对PC-PH的分类进行比较.
主要方法:
- 对242名患有左心脏病的患者进行了回顾性分析,这些患者接受了右心脏导管治疗 (RHC) 和心脏磁共振成像 (CMR).
- 使用旧的和新的ESC/ERS定义计算pc-PH和子组比例.
- 根据旧定义,单独考虑无法分类的pc-PH (Upc-PH) 病例.
主要成果:
- 新定义在242名患者中有76名 (31.4%) 发现了PC-PH,增加了5.5%.
- 根据新的定义,诊断从Ipc-PH (35名患者) 转移到Cpc-PH (41名患者),有4例新的Ipc-PH病例.
- 旧的定义导致了50个Ipc-PH,4个Cpc-PH和18个Upc-PH的诊断.
- 根据任何指南,没有CMR参数区分Ipc-PH和Cpc-PH.
结论:
- 2022年ESC/ERS指南的定义导致了整体PC-PH诊断的轻微增加,但Cpc-PH的明显增加.
- 这一变化归因于以前无法分类的PC-PH患者被重新分类到Cpc-PH亚组.
- 观察到从Ipc-PH到Cpc-PH的显著转变,突出显示了更新的定义对患者分层的影响.
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