风险分层和肺动脉高血压的治疗目标
Fabio Dardi1, Athénaïs Boucly2, Raymond Benza3
1Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
The European respiratory journal
|August 29, 2024
概括
肺动脉高血压 (PAH) 的风险分层使用非侵入性因素,但有局限性. 侵入性血液动力学和心脏成像可能为指导个性化PAH治疗决策提供额外的价值.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 医学诊断 医学诊断 医学诊断
背景情况:
- 风险分层对于预测肺动脉高血压 (PAH) 的结果至关重要.
- 目前的工具依赖于非侵入性参数,如功能类,步行6分钟的距离和性尿素.
- 这些参数在准确反映个人治疗决定的PAH严重程度方面存在局限性.
研究的目的:
- 评估PAH当前风险分层工具的充分性.
- 探索新型标记物的潜力,以指导个性化PAH治疗.
- 评估侵入性血液动力学和心脏成像在PAH管理中的附加值.
主要方法:
- 对PAH目前验证的风险分层工具的审查.
- 预后因素的分析,包括非侵入性和侵入性参数.
- 考虑新兴疗法及其对治疗指南的影响.
主要成果:
- 非侵入性参数是关键的,但可能缺乏指导个体PAH治疗的特异性.
- 肺血管重塑标志物在新的组合疗法中越来越重要.
- 初步数据表明,侵入性血液动力学和心脏成像提供增量价值.
结论:
- 虽然低死亡风险是目标,但目前的非侵入性方法可能不足以进行个性化PAH治疗.
- 侵入性血液动力学和心脏成像显示在完善治疗策略方面具有前景.
- 需要进一步的研究来将这些先进的方法整合到常规PAH护理中.
相关概念视频
Pulmonary Hypertension: Classification and Pathogenesis
158
Pulmonary hypertension (PH) is a severe health condition in which the mean pulmonary arterial pressure increases to 25 mmHg or more, even when the body is at rest. This high pressure in the blood vessels that transport blood from the heart to the lungs can cause various symptoms, including shortness of breath, can lead to right heart failure, and significantly affect the overall quality of life.
There are various classifications for PH, each relating to different underlying causes and also...
There are various classifications for PH, each relating to different underlying causes and also...
158
Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure
187
Oxygen therapy has emerged as a significant tool in enhancing the quality of life for patients suffering from pulmonary arterial hypertension (PAH). While this therapy has principally been studied on patients with significant hypoxemia, this therapeutic approach helps prevent potential organ damage and can be administered in the comfort of one's home.
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue,...
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue,...
187
Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
147
Receptor tyrosine kinase inhibitors (TKIs) and calcium channel blockers (CCBs) are two critical categories of drugs employed in the treatment of pulmonary artery hypertension (PAH). PAH is a disease that causes high blood pressure in the pulmonary arteries, resulting in chest pain, fatigue, and shortness of breath.
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
147
Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
160
Prostacyclin receptor agonists are a class of therapeutic agents integral to managing pulmonary arterial hypertension (PAH). These drugs operate by mimicking the action of prostaglandin I2, or PGI2, a naturally occurring compound in the body.
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
160
Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
142
Endothelins (ETs) are potent vasoactive peptides critical in the human body's various physiological and pathological processes. One of the most promising therapeutic strategies for treating pulmonary arterial hypertension (PAH) involves counteracting the effects of these endothelins using a class of drugs known as endothelin receptor antagonists.
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...
142
Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors
136
Phosphodiesterase 5 (PDE5) inhibitors are potent enzymes that function to hydrolyze cyclic nucleotides to their corresponding 5' monophosphates. Their unique biochemical properties have been applied in treating Pulmonary Arterial Hypertension (PAH).
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...
136


