液体挑战用于识别与左心病相关的肺高血压
Michele D'Alto1, Andrea Vergara1, Antonio Orlando1
1Adult Congenital Heart Disease Unit, Department of Cardiology, Monaldi Hospital, Naples, Italy.
Current opinion in pulmonary medicine
|August 6, 2025
概括
诊断肺高血压 (PH) 可能具有挑战性. 液体挑战测试有助于区分与左心病 (PH-LHD) 相关的PH和肺动脉高血压 (PAH),当初始测试没有确定性时.
科学领域:
- 心脏病学 心脏病学
- 肺部医学 肺部医学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 左心脏病 (LHD) 是肺高血压 (PH) 的主要原因.
- 与肺动脉高血压 (PAH) 相关的PH与LHD (PH-LHD) 的区别具有临床意义,但往往很困难.
- 肺动脉压 (PAWP) 在诊断右心脏导管治疗期间可能看起来正常或高正常,这会使诊断复杂化.
研究的目的:
- 评估液体挑战在区分PH-LHD和PAH方面的实用性.
- 为了解决PH患者和看似正常或高度正常的PAWP的诊断不确定性.
- 探索评估PH患者LHD的非侵入性方法.
主要方法:
- 对PAH和LHD的更新诊断指南的审查.
- 分析使用液体挑战 (例如,快速盐水输注) 来评估PAWP的研究.
- 对结合多普勒心声谱 (E/e'比率) 和肺超声波 (B线) 的非侵入性技术的初步数据的调查.
主要成果:
- 在500毫升盐水挑战后,PAWP超过18 mmHg强烈表明LHD.
- 建议在PH,心血管风险因素和高正常PAWP患者中进行液体挑战,以排除LHD.
- 涉及多普勒心声学 (E/e ≥12) 和肺超声波 (≥5B线) 的非侵入性方法对LHD评估有希望.
结论:
- 流体挑战是PH的诊断算法中一个有价值的工具.
- 该测试有助于区分PH-LHD和PAH,特别是在模两可的情况下.
- 非侵入性方法需要进一步调查PH的LHD诊断.
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