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首页> 外文期刊>Pulmonary Circulation >The Adrenergic System in Pulmonary Arterial Hypertension: Bench to Bedside (2013 Grover Conference Series):
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The Adrenergic System in Pulmonary Arterial Hypertension: Bench to Bedside (2013 Grover Conference Series):

机译：肺动脉高压中的肾上腺素系统：从长凳到床边（2013年格罗弗会议系列）：

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In heart failure with reduced left ventricular ejection fraction (HFrEF), adrenergic activation is a key compensatory mechanism that is a major contributor to progressive ventricular remodeling and worsening of heart failure. Targeting the increased adrenergic activation with β-adrenergic receptor blocking agents has led to the development of arguably the single most effective drug therapy for HFrEF. The pressure-overloaded and ultimately remodeled/failing right ventricle (RV) in pulmonary arterial hypertension (PAH) is also adrenergically activated, which raises the issue of whether an antiadrenergic strategy could be effectively employed in this setting. Anecdotal experience suggests that it will be challenging to administer an antiadrenergic treatment such as a β-blocking agent to patients with established moderate-severe PAH. However, the same types of data and commentary were prevalent early in the development of β-blockade for HFrEF treatment. In addition, in HFrEF approaches have been developed for delivering β-blocker therapy to patients who have extremely advanced heart failure, and these general principles could be applied to RV failure in PAH. This review examines the role played by adrenergic activation in the RV faced with PAH, contrasts PAH-RV remodeling with left ventricle remodeling in settings of sustained increases in afterload, and suggests a possible approach for safely delivering an antiadrenergic treatment to patients with RV dysfunction due to moderate-severe PAH.
机译：在降低左心室射血分数（HFrEF）的心力衰竭中，肾上腺素能激活是关键的补偿机制，这是进行性心室重构和心力衰竭恶化的主要因素。用β-肾上腺素能受体阻断剂靶向增加的肾上腺素能活化，导致了发展为HFrEF的最有效的单一药物疗法。肺动脉高压（PAH）中压力超负荷并最终重塑/右心室衰竭（RV）也被肾上腺素能激活，这引发了在这种情况下是否可以有效采用抗肾上腺素策略的问题。轶事经验表明，对患有中度重度PAH的患者进行抗肾上腺素能治疗，例如β受体阻滞剂，将是一个挑战。但是，在用于HFrEF治疗的β受体阻滞剂开发的早期，相同类型的数据和评论普遍存在。此外，在HFrEF中，已经开发出了向极度晚期心力衰竭患者提供β受体阻滞剂治疗的方法，这些通用原则可用于PAH的RV衰竭。这篇综述探讨了肾上腺素激活在面对PAH的RV中的作用，将PAH-RV重塑与左心室重塑在后负荷持续增加的情况下进行了对比，并提出了一种可能的方法，可安全地为因右室功能不全而导致的RV功能患者提供抗肾上腺素治疗中度至重度PAH。

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