[由于左心病引起的肺高血压]
Charles Fauvel1, Bouchra Lamia2, Nicolas Lamblin3
1Service de cardiologie, CHU de Rouen, Rouen, France.
La Revue du praticien
|June 6, 2025
概括
由于左心病 (PH-LHD) 的肺高血压是全球最常见的PH类型,与更差的生存率有关. 治疗重点是管理潜在的左心病,而不是肺血管扩张器.
科学领域:
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
- 内部医学 内部医学
背景情况:
- 由于左心病 (PH-LHD) 的肺高血压是全球肺高血压 (PH) 的主要原因.
- PH-LHD与患者短期和长期生存率显著下降有关.
- 准确的诊断和分类对于适当的管理策略至关重要.
研究的目的:
- 确定PH-LHD的诊断标准.
- 要区分分离散的毛细血管后PH (Ipc-PH) 和结合的毛细血管前和后PH (Cpc-PH).
- 概述目前PH-LHD的治疗建议.
主要方法:
- 诊断包括在休息状态下对右心脏进行导管.
- 血液动力学参数,包括肺动脉平均压力 (mPAP) 和肺动脉压力 (PAWP),进行测量.
- 肺血管阻力 (PVR) 的计算是为了区分Ipc-PH (PVR <2木单位) 和Cpc-PH (PVR ≥2木单位).
主要成果:
- 当mPAP>20 mmHg和PAWP>15 mmHg时,PH-LHD被诊断为mPAP>20 mmHg和PAWP>15 mmHg.
- 区分Ipc-PH和Cpc-PH对于预后和管理至关重要.
- 对PH-LHD (世界卫生组织第三组) 不建议使用肺血管扩张疗法.
结论:
- PH-LHD需要使用右心导管进行精确的诊断.
- 治疗PH-LHD的重点是优化治疗主要的左心病理.
- 在PH-LHD患者中,有效管理心力衰竭与保留/减少喷射分数或膜心脏病是关键.
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